- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $127.44 / $202.21
| Professional | | $113.25 | $127.44 | $202.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.11 / $120.15 / $150.19
| Professional | | $90.11 | $120.15 | $150.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.83 / $145.12 / $262.74
| Professional | | $109.83 | $145.12 | $262.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.28 / $142.74 / $784.05
| Professional | | $112.28 | $142.74 | $784.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.88 / $136.85 / $242.22
| Professional | | $109.88 | $136.85 | $242.22 |