- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.78 / $167.28 / $225.94
| Professional | | $119.78 | $167.28 | $225.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.70 / $113.27 / $200.32
| Professional | | $100.70 | $113.27 | $200.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.26 / $174.42 / $174.42
| Professional | | $148.26 | $174.42 | $174.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.82 / $194.92 / $260.27
| Professional | | $133.82 | $194.92 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.55 / $193.97 / $907.92
| Professional | | $142.55 | $193.97 | $907.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.83 / $175.34 / $277.97
| Professional | | $135.83 | $175.34 | $277.97 |