- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.55 / $183.53 / $227.16
| Professional | | $87.55 | $183.53 | $227.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.62 / $189.57 / $352.55
| Professional | | $105.62 | $189.57 | $352.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.68 / $217.79 / $450.82
| Professional | | $122.68 | $217.79 | $450.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.42 / $286.07 / $507.75
| Professional | | $122.42 | $286.07 | $507.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.59 / $115.25 / $232.59
| Professional | | $101.59 | $115.25 | $232.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.76 / $287.48 / $467.49
| Professional | | $206.76 | $287.48 | $467.49 |