- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.46 / $125.37 / $174.01
| Professional | | $105.46 | $125.37 | $174.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.52 / $166.07 / $300.91
| Professional | | $112.52 | $166.07 | $300.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.01 / $212.34 / $212.34
| Professional | | $178.01 | $212.34 | $212.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.77 / $152.41 / $219.00
| Professional | | $110.77 | $152.41 | $219.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.91 / $139.34 / $252.71
| Professional | | $106.91 | $139.34 | $252.71 |