- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $120.70 / $454.23
| Professional | | $81.06 | $120.70 | $454.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $125.40 / $180.77
| Professional | | $125.40 | $125.40 | $180.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.02 / $139.34 / $204.86
| Professional | | $84.02 | $139.34 | $204.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.36 / $161.28 / $238.56
| Professional | | $102.36 | $161.28 | $238.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.49 / $194.32 / $222.08
| Professional | | $161.49 | $194.32 | $222.08 |