- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.61 / $116.06 / $170.34
| Professional | | $90.61 | $116.06 | $170.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.02 / $125.02 / $125.02
| Professional | | $125.02 | $125.02 | $125.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.84 / $118.61 / $142.25
| Professional | | $92.84 | $118.61 | $142.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.62 / $128.58 / $171.26
| Professional | | $111.62 | $128.58 | $171.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.31 / $124.94 / $176.81
| Professional | | $88.31 | $124.94 | $176.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.63 / $130.31 / $167.43
| Professional | | $104.63 | $130.31 | $167.43 |