- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.10 / $144.04 / $214.28
| Professional | | $107.10 | $144.04 | $214.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.66 / $202.35 / $628.78
| Professional | | $166.66 | $202.35 | $628.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.75 / $158.40 / $418.63
| Professional | | $117.75 | $158.40 | $418.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.53 / $203.99 / $418.63
| Professional | | $142.53 | $203.99 | $418.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.55 / $199.40 / $579.67
| Professional | | $149.55 | $199.40 | $579.67 |