- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.22 / $125.22 / $253.46
| Professional | | $125.22 | $125.22 | $253.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.71 / $167.66 / $261.94
| Professional | | $145.71 | $167.66 | $261.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.86 / $186.12 / $266.64
| Professional | | $155.86 | $186.12 | $266.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.86 / $178.85 / $274.36
| Professional | | $138.86 | $178.85 | $274.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.22 / $125.22 / $253.46
| Professional | | $125.22 | $125.22 | $253.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.38 / $180.96 / $247.43
| Professional | | $145.38 | $180.96 | $247.43 |