- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.05 / $188.06 / $527.36
| Professional | | $122.05 | $188.06 | $527.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.13 / $126.02 / $164.37
| Professional | | $100.13 | $126.02 | $164.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.58 / $139.84 / $228.58
| Professional | | $109.58 | $139.84 | $228.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.57 / $180.86 / $296.08
| Professional | | $136.57 | $180.86 | $296.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.47 / $184.73 / $351.39
| Professional | | $144.47 | $184.73 | $351.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.23 / $110.75 / $172.38
| Professional | | $82.23 | $110.75 | $172.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $143.44 / $219.38
| Professional | | $114.04 | $143.44 | $219.38 |