- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.25 / $160.13 / $265.35
| Professional | | $115.25 | $160.13 | $265.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.30 / $173.38 / $256.02
| Professional | | $129.30 | $173.38 | $256.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $213.70 / $351.78
| Professional | | $143.69 | $213.70 | $351.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.56 / $207.75 / $323.26
| Professional | | $140.56 | $207.75 | $323.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.25 / $161.16 / $265.35
| Professional | | $115.25 | $161.16 | $265.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.00 / $206.69 / $338.97
| Professional | | $147.00 | $206.69 | $338.97 |