- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.05 / $113.38 / $130.07
| Professional | | $98.05 | $113.38 | $130.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.45 / $173.18 / $301.32
| Professional | | $114.45 | $173.18 | $301.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.70 / $107.70 / $128.28
| Professional | | $107.70 | $107.70 | $128.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.97 / $159.62 / $253.15
| Professional | | $123.97 | $159.62 | $253.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.82 / $1,002.90 / $1,002.90
| Professional | | $787.82 | $1,002.90 | $1,002.90 |