- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $616.60
| Professional | | $30.20 | $44.67 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $537.03
| Professional | | $245.47 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $60.26 / $75.86
| Professional | | $45.71 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $426.58 / $630.96
| Professional | | $40.74 | $426.58 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $60.26 / $81.28
| Professional | | $46.77 | $60.26 | $81.28 |