- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.45 / $106.33 / $155.63
| Professional | | $74.45 | $106.33 | $155.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.84 / $92.24 / $111.15
| Professional | | $72.84 | $92.24 | $111.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.92 / $142.13 / $262.27
| Professional | | $106.92 | $142.13 | $262.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.60 / $145.94 / $205.56
| Professional | | $120.60 | $145.94 | $205.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.53 / $122.62 / $190.58
| Professional | | $91.53 | $122.62 | $190.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.35 / $109.63 / $198.62
| Professional | | $91.35 | $109.63 | $198.62 |