- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.57 / $125.57 / $204.98
| Professional | | $94.57 | $125.57 | $204.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.68 / $192.35 / $282.11
| Professional | | $107.68 | $192.35 | $282.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.09 / $244.29 / $423.46
| Professional | | $136.09 | $244.29 | $423.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.47 / $246.21 / $481.19
| Professional | | $124.47 | $246.21 | $481.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.04 / $212.54 / $433.09
| Professional | | $166.04 | $212.54 | $433.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.73 / $104.76 / $140.56
| Professional | | $73.73 | $104.76 | $140.56 |