- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.35 / $190.84 / $363.85
| Professional | | $189.35 | $190.84 | $363.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.75 / $375.11 / $1,118.05
| Professional | | $314.75 | $375.11 | $1,118.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.58 / $320.51 / $660.06
| Professional | | $211.58 | $320.51 | $660.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.83 / $376.28 / $660.06
| Professional | | $219.83 | $376.28 | $660.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.22 / $414.58 / $1,205.22
| Professional | | $284.22 | $414.58 | $1,205.22 |