- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.26 / $81.50 / $154.08
| Professional | | $64.26 | $81.50 | $154.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.39 / $206.87 / $315.70
| Professional | | $183.39 | $206.87 | $315.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.94 / $113.16 / $248.62
| Professional | | $71.94 | $113.16 | $248.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.28 / $128.16 / $248.62
| Professional | | $74.28 | $128.16 | $248.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.86 / $185.30 / $349.48
| Professional | | $113.86 | $185.30 | $349.48 |