- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.21 / $113.09 / $219.21
| Professional | | $48.21 | $113.09 | $219.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.08 / $175.08 / $472.92
| Professional | | $175.08 | $175.08 | $472.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.62 / $164.90 / $472.92
| Professional | | $74.62 | $164.90 | $472.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.63 / $173.19 / $472.92
| Professional | | $75.63 | $173.19 | $472.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.94 / $176.58 / $513.34
| Professional | | $109.94 | $176.58 | $513.34 |