- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.84 / $128.33 / $187.31
| Professional | | $96.84 | $128.33 | $187.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.35 / $151.83 / $222.08
| Professional | | $115.35 | $151.83 | $222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.89 / $100.12 / $131.97
| Professional | | $74.89 | $100.12 | $131.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.20 / $158.19 / $201.62
| Professional | | $126.20 | $158.19 | $201.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.47 / $135.60 / $266.36
| Professional | | $118.47 | $135.60 | $266.36 |