- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.38 / $153.36 / $331.84
| Professional | | $129.38 | $153.36 | $331.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.47 / $213.57 / $312.08
| Professional | | $144.47 | $213.57 | $312.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.28 / $175.73 / $281.68
| Professional | | $112.28 | $175.73 | $281.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.84 / $178.86 / $297.47
| Professional | | $108.84 | $178.86 | $297.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.76 / $142.28 / $194.64
| Professional | | $129.76 | $142.28 | $194.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $196.72 / $327.24
| Professional | | $145.00 | $196.72 | $327.24 |