- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.85 / $210.58 / $324.87
| Professional | | $138.85 | $210.58 | $324.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.59 / $157.16 / $247.43
| Professional | | $124.59 | $157.16 | $247.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.55 / $212.72 / $352.14
| Professional | | $163.55 | $212.72 | $352.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.07 / $283.32 / $469.04
| Professional | | $186.07 | $283.32 | $469.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $56.62 / $251.53
| Professional | | $32.34 | $56.62 | $251.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.81 / $301.44 / $470.98
| Professional | | $212.81 | $301.44 | $470.98 |