- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $123.74 / $454.23
| Professional | | $81.06 | $123.74 | $454.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.36 / $139.08 / $232.87
| Professional | | $102.36 | $139.08 | $232.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.56 / $91.08 / $112.17
| Professional | | $71.56 | $91.08 | $112.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.58 / $184.70 / $282.93
| Professional | | $115.58 | $184.70 | $282.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $131.86 / $214.79
| Professional | | $106.45 | $131.86 | $214.79 |