- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.97 / $232.76 / $520.16
| Professional | | $156.97 | $232.76 | $520.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.84 / $243.43 / $382.33
| Professional | | $117.84 | $243.43 | $382.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.51 / $280.00 / $456.59
| Professional | | $187.51 | $280.00 | $456.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $43.50 / $362.53
| Professional | | $32.34 | $43.50 | $362.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.02 / $291.70 / $496.47
| Professional | | $194.02 | $291.70 | $496.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.74 / $377.90 / $600.20
| Professional | | $265.74 | $377.90 | $600.20 |