- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.87 / $188.56 / $213.03
| Professional | | $135.87 | $188.56 | $213.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.88 / $194.84 / $227.32
| Professional | | $141.88 | $194.84 | $227.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.82 / $229.99 / $255.54
| Professional | | $210.82 | $229.99 | $255.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $202.77
| Professional | | $32.34 | $32.34 | $202.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.58 / $204.47 / $238.63
| Professional | | $193.58 | $204.47 | $238.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.34 / $176.44 / $240.83
| Professional | | $136.34 | $176.44 | $240.83 |