- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.82 / $133.65 / $161.62
| Professional | | $109.82 | $133.65 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.26 / $248.41 / $414.10
| Professional | | $168.26 | $248.41 | $414.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.10 / $348.63 / $515.07
| Professional | | $206.10 | $348.63 | $515.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.77 / $302.12 / $465.40
| Professional | | $202.77 | $302.12 | $465.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.90 / $177.26 / $427.76
| Professional | | $109.90 | $177.26 | $427.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.90 / $166.14 / $393.19
| Professional | | $109.90 | $166.14 | $393.19 |