- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.67 / $139.52 / $268.39
| Professional | | $102.67 | $139.52 | $268.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.13 / $188.08 / $269.61
| Professional | | $140.13 | $188.08 | $269.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.85 / $236.17 / $346.15
| Professional | | $156.85 | $236.17 | $346.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.75 / $209.41 / $349.08
| Professional | | $153.75 | $209.41 | $349.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.67 / $153.31 / $303.02
| Professional | | $102.67 | $153.31 | $303.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.00 / $242.57 / $337.56
| Professional | | $143.00 | $242.57 | $337.56 |