- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.26 / $90.62 / $110.54
| Professional | | $76.26 | $90.62 | $110.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.32 / $129.66 / $154.36
| Professional | | $117.32 | $129.66 | $154.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.89 / $168.52 / $401.21
| Professional | | $60.89 | $168.52 | $401.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.51 / $94.38 / $127.02
| Professional | | $81.51 | $94.38 | $127.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.15 / $101.62 / $147.35
| Professional | | $82.15 | $101.62 | $147.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.72 / $105.02 / $146.97
| Professional | | $86.72 | $105.02 | $146.97 |