- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.13 / $163.19 / $337.54
| Professional | | $109.13 | $163.19 | $337.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.44 / $108.44 / $118.20
| Professional | | $108.44 | $108.44 | $118.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.86 / $185.13 / $480.37
| Professional | | $88.86 | $185.13 | $480.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.15 / $542.83 / $542.83
| Professional | | $195.15 | $542.83 | $542.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.02 / $276.22 / $687.42
| Professional | | $197.02 | $276.22 | $687.42 |