- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.74 / $149.02 / $203.75
| Professional | | $100.74 | $149.02 | $203.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.10 / $183.22 / $250.45
| Professional | | $110.10 | $183.22 | $250.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.53 / $234.47 / $434.82
| Professional | | $154.53 | $234.47 | $434.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.43 / $246.82 / $447.94
| Professional | | $137.43 | $246.82 | $447.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.45 / $240.16 / $471.42
| Professional | | $167.45 | $240.16 | $471.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.23 / $122.12 / $149.54
| Professional | | $87.23 | $122.12 | $149.54 |