- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.50 / $145.06 / $248.56
| Professional | | $129.50 | $145.06 | $248.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.07 / $125.81 / $128.41
| Professional | | $104.07 | $125.81 | $128.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.36 / $132.04 / $190.03
| Professional | | $96.36 | $132.04 | $190.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.53 / $140.84 / $307.69
| Professional | | $105.53 | $140.84 | $307.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.00 / $1,624.00 / $1,624.00
| Professional | | $1,624.00 | $1,624.00 | $1,624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.85 / $147.99 / $269.27
| Professional | | $108.85 | $147.99 | $269.27 |