- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.01 / $138.74 / $207.52
| Professional | | $110.01 | $138.74 | $207.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.47 / $147.32 / $147.32
| Professional | | $72.47 | $147.32 | $147.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.55 / $174.90 / $204.12
| Professional | | $130.55 | $174.90 | $204.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.58 / $175.64 / $244.03
| Professional | | $122.58 | $175.64 | $244.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.57 / $163.36 / $976.46
| Professional | | $119.57 | $163.36 | $976.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.42 / $146.83 / $232.36
| Professional | | $117.42 | $146.83 | $232.36 |