- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $309.03
| Professional | | $102.33 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $165.96 / $239.88
| Professional | | $109.65 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $194.98 / $316.23
| Professional | | $138.04 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $389.05
| Professional | | $138.04 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $407.38
| Professional | | $114.82 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $165.96 / $331.13
| Professional | | $109.65 | $165.96 | $331.13 |