- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.78 / $168.60 / $203.31
| Professional | | $153.78 | $168.60 | $203.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.61 / $227.26 / $338.16
| Professional | | $175.61 | $227.26 | $338.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.06 / $262.89 / $367.52
| Professional | | $186.06 | $262.89 | $367.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.70 / $246.09 / $377.52
| Professional | | $212.70 | $246.09 | $377.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.71 / $175.81 / $203.31
| Professional | | $137.71 | $175.81 | $203.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.50 / $238.45 / $335.36
| Professional | | $166.50 | $238.45 | $335.36 |