- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.18 / $121.85 / $160.76
| Professional | | $87.18 | $121.85 | $160.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.29 / $179.52 / $490.66
| Professional | | $152.29 | $179.52 | $490.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.11 / $187.12 / $302.02
| Professional | | $131.11 | $187.12 | $302.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.44 / $187.69 / $302.02
| Professional | | $138.44 | $187.69 | $302.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.83 / $189.70 / $551.47
| Professional | | $162.83 | $189.70 | $551.47 |