- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $190.55 / $323.59
| Professional | | $104.71 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $162.18 / $181.97
| Professional | | $138.04 | $162.18 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $177.83 / $354.81
| Professional | | $91.20 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $128.82 / $239.88
| Professional | | $120.23 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $112.20 / $275.42
| Professional | | $32.36 | $112.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $323.59
| Professional | | $91.20 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $158.49
| Professional | | $77.62 | $77.62 | $158.49 |