- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $213.80
| Professional | | $120.23 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $177.83 / $316.23
| Professional | | $117.49 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $223.87
| Professional | | $32.36 | $33.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $316.23
| Professional | | $141.25 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $234.42 / $288.40
| Professional | | $128.82 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $251.19
| Professional | | $141.25 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $245.47
| Professional | | $120.23 | $151.36 | $245.47 |