- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.52 / $127.44 / $177.19
| Professional | | $114.52 | $127.44 | $177.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.24 / $137.76 / $228.57
| Professional | | $97.24 | $137.76 | $228.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.38 / $141.04 / $223.90
| Professional | | $112.38 | $141.04 | $223.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.05 / $784.05 / $1,017.38
| Professional | | $784.05 | $784.05 | $1,017.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.94 / $134.86 / $262.18
| Professional | | $105.94 | $134.86 | $262.18 |