- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.65 / $91.43 / $423.95
| Professional | | $47.65 | $91.43 | $423.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.25 / $101.68 / $266.61
| Professional | | $86.25 | $101.68 | $266.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.13 / $109.21 / $266.61
| Professional | | $76.13 | $109.21 | $266.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.03 / $109.21 / $210.31
| Professional | | $82.03 | $109.21 | $210.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.31 / $111.90 / $190.33
| Professional | | $79.31 | $111.90 | $190.33 |