- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.94 / $192.84 / $276.70
| Professional | | $105.94 | $192.84 | $276.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.70 / $170.44 / $268.50
| Professional | | $103.70 | $170.44 | $268.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.85 / $233.82 / $292.27
| Professional | | $194.85 | $233.82 | $292.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.05 / $193.27 / $361.24
| Professional | | $112.05 | $193.27 | $361.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.68 / $229.46 / $434.43
| Professional | | $167.68 | $229.46 | $434.43 |