- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.86 / $150.25 / $239.36
| Professional | | $125.86 | $150.25 | $239.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.05 / $177.70 / $207.74
| Professional | | $151.05 | $177.70 | $207.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.61 / $189.43 / $304.64
| Professional | | $140.61 | $189.43 | $304.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.51 / $206.91 / $1,150.72
| Professional | | $155.51 | $206.91 | $1,150.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.16 / $179.08 / $250.22
| Professional | | $155.16 | $179.08 | $250.22 |