- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.33 / $105.46 / $207.17
| Professional | | $81.33 | $105.46 | $207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.64 / $119.41 / $172.12
| Professional | | $111.64 | $119.41 | $172.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.10 / $153.16 / $227.72
| Professional | | $101.10 | $153.16 | $227.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.69 / $104.66 / $166.64
| Professional | | $97.69 | $104.66 | $166.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.29 / $137.09 / $201.84
| Professional | | $94.29 | $137.09 | $201.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.18 / $128.68 / $215.34
| Professional | | $96.18 | $128.68 | $215.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.83 / $72.83 / $72.83
| Professional | | $72.83 | $72.83 | $72.83 |