- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.55 / $114.97 / $240.27
| Professional | | $83.55 | $114.97 | $240.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.86 / $147.08 / $223.52
| Professional | | $104.86 | $147.08 | $223.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.91 / $176.10 / $285.25
| Professional | | $111.91 | $176.10 | $285.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.13 / $183.18 / $305.35
| Professional | | $126.13 | $183.18 | $305.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.55 / $114.97 / $240.27
| Professional | | $83.55 | $114.97 | $240.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.43 / $180.42 / $291.43
| Professional | | $138.43 | $180.42 | $291.43 |