- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.25 / $261.39 / $459.14
| Professional | | $114.25 | $261.39 | $459.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $177.16 / $517.73
| Professional | | $129.63 | $177.16 | $517.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.97 / $183.53 / $588.05
| Professional | | $141.97 | $183.53 | $588.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $417.01 / $524.63
| Professional | | $32.34 | $417.01 | $524.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.55 / $168.06 / $553.22
| Professional | | $135.55 | $168.06 | $553.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.42 / $404.50 / $522.66
| Professional | | $307.42 | $404.50 | $522.66 |