- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.84 / $199.54 / $270.04
| Professional | | $127.84 | $199.54 | $270.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.92 / $133.66 / $184.45
| Professional | | $106.92 | $133.66 | $184.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.90 / $257.23 / $370.41
| Professional | | $209.90 | $257.23 | $370.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.81 / $215.91 / $467.51
| Professional | | $133.81 | $215.91 | $467.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.68 / $240.93 / $446.47
| Professional | | $200.68 | $240.93 | $446.47 |