- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.07 / $126.73 / $194.04
| Professional | | $110.07 | $126.73 | $194.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.81 / $328.22 / $429.52
| Professional | | $173.81 | $328.22 | $429.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.01 / $281.35 / $344.42
| Professional | | $192.01 | $281.35 | $344.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.23 / $271.20 / $284.80
| Professional | | $193.23 | $271.20 | $284.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.95 / $249.02 / $779.72
| Professional | | $125.95 | $249.02 | $779.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.51 / $230.34 / $378.48
| Professional | | $124.51 | $230.34 | $378.48 |