- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.41 / $108.69 / $195.57
| Professional | | $73.41 | $108.69 | $195.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.85 / $188.02 / $483.98
| Professional | | $154.85 | $188.02 | $483.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.30 / $163.32 / $415.27
| Professional | | $101.30 | $163.32 | $415.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.17 / $168.73 / $415.27
| Professional | | $102.17 | $168.73 | $415.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.09 / $170.31 / $495.10
| Professional | | $124.09 | $170.31 | $495.10 |