- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.65 / $194.18 / $311.36
| Professional | | $141.65 | $194.18 | $311.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.32 / $209.15 / $264.92
| Professional | | $159.32 | $209.15 | $264.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.95 / $248.42 / $298.24
| Professional | | $204.95 | $248.42 | $298.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $242.90 / $270.66
| Professional | | $32.34 | $242.90 | $270.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.55 / $261.17 / $307.52
| Professional | | $217.55 | $261.17 | $307.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.87 / $232.70 / $338.48
| Professional | | $166.87 | $232.70 | $338.48 |