- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.41 / $120.13 / $175.40
| Professional | | $105.41 | $120.13 | $175.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.64 / $152.25 / $226.08
| Professional | | $117.64 | $152.25 | $226.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.13 / $176.28 / $245.18
| Professional | | $124.13 | $176.28 | $245.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.21 / $164.54 / $252.41
| Professional | | $142.21 | $164.54 | $252.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $136.33 / $167.39
| Professional | | $106.00 | $136.33 | $167.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.64 / $159.88 / $223.73
| Professional | | $111.64 | $159.88 | $223.73 |