- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.52 / $152.57 / $260.69
| Professional | | $95.52 | $152.57 | $260.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.59 / $190.13 / $582.61
| Professional | | $156.59 | $190.13 | $582.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.66 / $163.35 / $434.85
| Professional | | $104.66 | $163.35 | $434.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $216.84 / $434.85
| Professional | | $137.41 | $216.84 | $434.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.68 / $211.57 / $615.04
| Professional | | $158.68 | $211.57 | $615.04 |