- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.33 / $217.84 / $217.84
| Professional | | $157.33 | $217.84 | $217.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.87 / $233.58 / $315.39
| Professional | | $200.87 | $233.58 | $315.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.94 / $267.83 / $377.44
| Professional | | $216.94 | $267.83 | $377.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.41 / $237.51 / $364.35
| Professional | | $184.41 | $237.51 | $364.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.33 / $217.84 / $217.84
| Professional | | $157.33 | $217.84 | $217.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.42 / $253.47 / $331.48
| Professional | | $208.42 | $253.47 | $331.48 |