- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $204.17
| Professional | | $114.82 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $138.04 / $138.04
| Professional | | $109.65 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $223.87
| Professional | | $114.82 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $144.54 / $199.53
| Professional | | $112.20 | $144.54 | $199.53 |