- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $116.16 / $290.00
| Professional | | $40.65 | $116.16 | $290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.19 / $128.84 / $382.28
| Professional | | $48.19 | $128.84 | $382.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.45 / $131.60 / $418.35
| Professional | | $54.45 | $131.60 | $418.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.03 / $256.82 / $450.97
| Professional | | $188.03 | $256.82 | $450.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.56 / $232.45 / $640.25
| Professional | | $123.56 | $232.45 | $640.25 |