- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.85 / $132.81 / $202.77
| Professional | | $103.85 | $132.81 | $202.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.13 / $194.20 / $408.04
| Professional | | $116.13 | $194.20 | $408.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.13 / $250.59 / $306.85
| Professional | | $191.13 | $250.59 | $306.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.02 / $159.52 / $253.39
| Professional | | $93.02 | $159.52 | $253.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.72 / $212.24 / $348.28
| Professional | | $142.72 | $212.24 | $348.28 |