- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.77 / $126.48 / $265.44
| Professional | | $90.77 | $126.48 | $265.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.32 / $163.92 / $247.40
| Professional | | $119.32 | $163.92 | $247.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.25 / $193.63 / $313.80
| Professional | | $123.25 | $193.63 | $313.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.91 / $202.75 / $337.97
| Professional | | $138.91 | $202.75 | $337.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.77 / $126.48 / $265.44
| Professional | | $90.77 | $126.48 | $265.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.22 / $216.47 / $354.78
| Professional | | $152.22 | $216.47 | $354.78 |