- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.87 / $187.53 / $322.42
| Professional | | $116.87 | $187.53 | $322.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.05 / $143.38 / $263.63
| Professional | | $101.05 | $143.38 | $263.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.40 / $196.98 / $196.98
| Professional | | $148.40 | $196.98 | $196.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.09 / $192.59 / $333.83
| Professional | | $131.09 | $192.59 | $333.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.03 / $202.15 / $333.83
| Professional | | $136.03 | $202.15 | $333.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.34 / $193.79 / $277.47
| Professional | | $130.34 | $193.79 | $277.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.76 / $202.75 / $354.56
| Professional | | $139.76 | $202.75 | $354.56 |