- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.09 / $118.38 / $226.92
| Professional | | $76.09 | $118.38 | $226.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.76 / $162.85 / $222.85
| Professional | | $86.76 | $162.85 | $222.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.83 / $181.82 / $284.87
| Professional | | $124.83 | $181.82 | $284.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.69 / $168.80 / $211.41
| Professional | | $110.69 | $168.80 | $211.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.46 / $198.31 / $329.52
| Professional | | $101.46 | $198.31 | $329.52 |