- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.77 / $115.20 / $134.25
| Professional | | $87.77 | $115.20 | $134.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.37 / $145.19 / $214.28
| Professional | | $112.37 | $145.19 | $214.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.64 / $138.43 / $242.08
| Professional | | $83.64 | $138.43 | $242.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.21 / $139.74 / $248.02
| Professional | | $88.21 | $139.74 | $248.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.76 / $115.20 / $179.81
| Professional | | $87.76 | $115.20 | $179.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $159.02 / $283.30
| Professional | | $114.04 | $159.02 | $283.30 |