- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.36 / $158.32 / $183.36
| Professional | | $140.36 | $158.32 | $183.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.00 / $96.05 / $182.08
| Professional | | $54.00 | $96.05 | $182.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.57 / $206.41 / $382.18
| Professional | | $157.57 | $206.41 | $382.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $290.00 / $429.67
| Professional | | $100.00 | $290.00 | $429.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.64 / $147.66 / $229.84
| Professional | | $109.64 | $147.66 | $229.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.69 / $173.59 / $266.62
| Professional | | $137.69 | $173.59 | $266.62 |