- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $125.89 / $223.87
| Professional | | $112.20 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $117.49 / $380.19
| Professional | | $104.71 | $117.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $309.03
| Professional | | $120.23 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $141.25 / $245.47
| Professional | | $107.15 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,023.29
| Professional | | $776.25 | $1,023.29 | $1,023.29 |