- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $139.86 / $240.41
| Professional | | $106.17 | $139.86 | $240.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.30 / $161.32 / $237.49
| Professional | | $127.30 | $161.32 | $237.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.24 / $214.07 / $313.08
| Professional | | $145.24 | $214.07 | $313.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.80 / $182.19 / $283.49
| Professional | | $141.80 | $182.19 | $283.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.03 / $139.86 / $215.24
| Professional | | $109.03 | $139.86 | $215.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.15 / $201.06 / $296.55
| Professional | | $148.15 | $201.06 | $296.55 |