- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.92 / $127.44 / $172.25
| Professional | | $108.92 | $127.44 | $172.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.93 / $195.55 / $232.80
| Professional | | $176.93 | $195.55 | $232.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.00 / $141.04 / $362.94
| Professional | | $90.00 | $141.04 | $362.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.71 / $139.62 / $180.07
| Professional | | $117.71 | $139.62 | $180.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.37 / $133.81 / $187.42
| Professional | | $109.37 | $133.81 | $187.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.44 / $149.63 / $202.25
| Professional | | $122.44 | $149.63 | $202.25 |