- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $128.82 / $331.13
| Professional | | $104.71 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $257.04
| Professional | | $100.00 | $173.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $251.19
| Professional | | $131.83 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $281.84
| Professional | | $123.03 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $338.84
| Professional | | $109.65 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $151.36 / $223.87
| Professional | | $102.33 | $151.36 | $223.87 |