- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.04 / $180.63 / $232.60
| Professional | | $157.04 | $180.63 | $232.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $184.50 / $289.56
| Professional | | $184.50 | $184.50 | $289.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.58 / $198.33 / $297.50
| Professional | | $168.58 | $198.33 | $297.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.32 / $257.83 / $274.42
| Professional | | $250.32 | $257.83 | $274.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $316.64
| Professional | | $32.34 | $32.34 | $316.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.55 / $280.05 / $415.86
| Professional | | $200.55 | $280.05 | $415.86 |