- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.47 / $150.75 / $212.84
| Professional | | $130.47 | $150.75 | $212.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.86 / $176.30 / $176.30
| Professional | | $149.86 | $176.30 | $176.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.61 / $187.89 / $254.87
| Professional | | $132.61 | $187.89 | $254.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.41 / $179.29 / $886.02
| Professional | | $148.41 | $179.29 | $886.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.61 / $166.95 / $257.98
| Professional | | $140.61 | $166.95 | $257.98 |