- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.41 / $150.41 / $167.87
| Professional | | $150.41 | $150.41 | $167.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.10 / $155.78 / $234.25
| Professional | | $138.10 | $155.78 | $234.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.16 / $174.09 / $249.42
| Professional | | $145.16 | $174.09 | $249.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.38 / $164.06 / $251.68
| Professional | | $127.38 | $164.06 | $251.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.41 / $150.41 / $167.87
| Professional | | $150.41 | $150.41 | $167.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.80 / $168.84 / $228.05
| Professional | | $141.80 | $168.84 | $228.05 |