- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.62 / $125.03 / $178.70
| Professional | | $107.62 | $125.03 | $178.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.43 / $131.59 / $156.59
| Professional | | $118.43 | $131.59 | $156.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.97 / $171.77 / $336.76
| Professional | | $102.97 | $171.77 | $336.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.25 / $147.04 / $200.51
| Professional | | $100.25 | $147.04 | $200.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.61 / $128.90 / $261.47
| Professional | | $76.61 | $128.90 | $261.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.33 / $153.13 / $191.42
| Professional | | $107.33 | $153.13 | $191.42 |