- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.63 / $104.07 / $104.49
| Professional | | $100.63 | $104.07 | $104.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.65 / $206.58 / $258.22
| Professional | | $167.65 | $206.58 | $258.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.56 / $186.64 / $3,176.85
| Professional | | $113.56 | $186.64 | $3,176.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.00 / $194.70 / $262.75
| Professional | | $118.00 | $194.70 | $262.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.24 / $165.68 / $188.89
| Professional | | $120.24 | $165.68 | $188.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.56 / $180.46 / $229.98
| Professional | | $113.56 | $180.46 | $229.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.10 / $225.20 / $225.20
| Professional | | $184.10 | $225.20 | $225.20 |