- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.40 / $203.86 / $413.47
| Professional | | $110.40 | $203.86 | $413.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.60 / $168.88 / $236.54
| Professional | | $140.60 | $168.88 | $236.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.16 / $264.75 / $516.50
| Professional | | $152.16 | $264.75 | $516.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.34 / $293.27 / $507.97
| Professional | | $153.34 | $293.27 | $507.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.13 / $203.86 / $413.47
| Professional | | $130.13 | $203.86 | $413.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.24 / $353.68 / $552.86
| Professional | | $237.24 | $353.68 | $552.86 |