- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.13 / $127.10 / $203.76
| Professional | | $75.13 | $127.10 | $203.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.01 / $197.09 / $585.79
| Professional | | $162.01 | $197.09 | $585.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.50 / $167.54 / $455.81
| Professional | | $79.50 | $167.54 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.21 / $211.31 / $455.81
| Professional | | $106.21 | $211.31 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.97 / $197.48 / $658.06
| Professional | | $149.97 | $197.48 | $658.06 |