- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.40 / $158.69 / $164.84
| Professional | | $140.40 | $158.69 | $164.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.72 / $328.00 / $442.44
| Professional | | $156.72 | $328.00 | $442.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.17 / $262.20 / $482.78
| Professional | | $194.17 | $262.20 | $482.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.59 / $108.59 / $108.59
| Professional | | $108.59 | $108.59 | $108.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.96 / $107.83 / $218.45
| Professional | | $57.96 | $107.83 | $218.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.86 / $255.50 / $383.78
| Professional | | $182.86 | $255.50 | $383.78 |