- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.89 / $142.58 / $187.53
| Professional | | $104.89 | $142.58 | $187.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.69 / $134.05 / $203.00
| Professional | | $94.69 | $134.05 | $203.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.32 / $169.70 / $253.79
| Professional | | $131.32 | $169.70 | $253.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.83 / $181.85 / $321.12
| Professional | | $113.83 | $181.85 | $321.12 |
- 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
- $143.13 / $202.36 / $324.13
| Professional | | $143.13 | $202.36 | $324.13 |