- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.46 / $156.66 / $343.61
| Professional | | $113.46 | $156.66 | $343.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.10 / $273.74 / $385.08
| Professional | | $184.10 | $273.74 | $385.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.24 / $323.82 / $495.15
| Professional | | $194.24 | $323.82 | $495.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.94 / $325.64 / $506.70
| Professional | | $220.94 | $325.64 | $506.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.11 / $234.71 / $357.71
| Professional | | $142.11 | $234.71 | $357.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.66 / $271.18 / $521.61
| Professional | | $182.66 | $271.18 | $521.61 |