- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.00 / $128.83 / $176.03
| Professional | | $113.00 | $128.83 | $176.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $125.83 / $179.62
| Professional | | $105.71 | $125.83 | $179.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.13 / $150.57 / $215.10
| Professional | | $105.13 | $150.57 | $215.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.47 / $168.14 / $267.94
| Professional | | $120.47 | $168.14 | $267.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.31 / $168.27 / $234.15
| Professional | | $111.31 | $168.27 | $234.15 |