- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.24 / $180.60 / $254.64
| Professional | | $137.24 | $180.60 | $254.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.22 / $181.91 / $319.32
| Professional | | $133.22 | $181.91 | $319.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.63 / $142.06 / $191.32
| Professional | | $102.63 | $142.06 | $191.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.94 / $222.86 / $289.62
| Professional | | $165.94 | $222.86 | $289.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.12 / $179.37 / $357.85
| Professional | | $142.12 | $179.37 | $357.85 |