- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.25 / $101.14 / $101.14
| Professional | | $96.25 | $101.14 | $101.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.24 / $111.15 / $340.80
| Professional | | $92.24 | $111.15 | $340.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.81 / $133.91 / $379.75
| Professional | | $102.81 | $133.91 | $379.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.04 / $145.94 / $145.94
| Professional | | $137.04 | $145.94 | $145.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.35 / $139.22 / $362.41
| Professional | | $90.35 | $139.22 | $362.41 |