- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.25 / $115.31 / $196.27
| Professional | | $69.25 | $115.31 | $196.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.27 / $124.73 / $262.67
| Professional | | $101.27 | $124.73 | $262.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.82 / $77.79 / $94.87
| Professional | | $58.82 | $77.79 | $94.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.90 / $203.90 / $226.55
| Professional | | $203.90 | $203.90 | $226.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.10 / $123.42 / $199.66
| Professional | | $110.10 | $123.42 | $199.66 |