- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.96 / $219.77 / $267.63
| Professional | | $146.96 | $219.77 | $267.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.72 / $272.52 / $448.05
| Professional | | $176.72 | $272.52 | $448.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.58 / $317.91 / $592.40
| Professional | | $194.58 | $317.91 | $592.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.00 / $2,091.84 / $2,423.69
| Professional | | $1,423.00 | $2,091.84 | $2,423.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.62 / $319.83 / $587.30
| Professional | | $251.62 | $319.83 | $587.30 |