- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $120.50 / $238.79
| Professional | | $81.06 | $120.50 | $238.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.66 / $128.40 / $226.78
| Professional | | $87.66 | $128.40 | $226.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.26 / $155.86 / $269.08
| Professional | | $98.26 | $155.86 | $269.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.24 / $152.02 / $311.27
| Professional | | $104.24 | $152.02 | $311.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.87 / $150.77 / $224.10
| Professional | | $86.87 | $150.77 | $224.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $165.92 / $284.33
| Professional | | $106.45 | $165.92 | $284.33 |