- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.87 / $128.15 / $190.93
| Professional | | $113.87 | $128.15 | $190.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.60 / $161.24 / $220.64
| Professional | | $124.60 | $161.24 | $220.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.80 / $167.44 / $263.83
| Professional | | $141.80 | $167.44 | $263.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.98 / $141.55 / $248.75
| Professional | | $82.98 | $141.55 | $248.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.87 / $137.59 / $195.28
| Professional | | $113.87 | $137.59 | $195.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.61 / $167.39 / $236.54
| Professional | | $115.61 | $167.39 | $236.54 |