- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.72 / $132.88 / $168.54
| Professional | | $78.72 | $132.88 | $168.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.42 / $174.35 / $273.81
| Professional | | $107.42 | $174.35 | $273.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.62 / $195.29 / $368.94
| Professional | | $106.62 | $195.29 | $368.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.89 / $209.24 / $374.06
| Professional | | $117.89 | $209.24 | $374.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.72 / $139.49 / $209.44
| Professional | | $78.72 | $139.49 | $209.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.37 / $253.78 / $367.87
| Professional | | $150.37 | $253.78 | $367.87 |