- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $120.28 / $256.77
| Professional | | $106.17 | $120.28 | $256.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.56 / $190.48 / $275.95
| Professional | | $145.56 | $190.48 | $275.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.09 / $217.51 / $302.44
| Professional | | $160.09 | $217.51 | $302.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.49 / $214.61 / $402.66
| Professional | | $185.49 | $214.61 | $402.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $130.09 / $276.91
| Professional | | $106.17 | $130.09 | $276.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.29 / $167.82 / $312.67
| Professional | | $114.29 | $167.82 | $312.67 |