- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.15 / $110.50 / $342.65
| Professional | | $75.15 | $110.50 | $342.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.83 / $301.83 / $301.83
| Professional | | $301.83 | $301.83 | $301.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.76 / $104.76 / $104.76
| Professional | | $104.76 | $104.76 | $104.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.07 / $337.00 / $426.93
| Professional | | $164.07 | $337.00 | $426.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $45.00 / $80.00
| Professional | | $25.00 | $45.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.81 / $89.47 / $204.56
| Professional | | $63.81 | $89.47 | $204.56 |