- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.93 / $124.52 / $215.11
| Professional | | $84.93 | $124.52 | $215.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.87 / $131.37 / $178.03
| Professional | | $88.87 | $131.37 | $178.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.70 / $153.55 / $253.74
| Professional | | $99.70 | $153.55 | $253.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.26 / $163.84 / $171.16
| Professional | | $139.26 | $163.84 | $171.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.50 / $150.57 / $259.27
| Professional | | $109.50 | $150.57 | $259.27 |