- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.86 / $117.16 / $163.29
| Professional | | $95.86 | $117.16 | $163.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.01 / $137.01 / $182.22
| Professional | | $137.01 | $137.01 | $182.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.00 / $141.00 / $389.01
| Professional | | $90.00 | $141.00 | $389.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.20 / $137.26 / $336.76
| Professional | | $109.20 | $137.26 | $336.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.04 / $147.07 / $376.41
| Professional | | $108.04 | $147.07 | $376.41 |