- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.38 / $167.25 / $262.04
| Professional | | $166.38 | $167.25 | $262.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.58 / $789.58 / $789.58
| Professional | | $789.58 | $789.58 | $789.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.39 / $281.77 / $490.95
| Professional | | $192.39 | $281.77 | $490.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.39 / $285.47 / $490.95
| Professional | | $192.39 | $285.47 | $490.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.22 / $308.36 / $497.57
| Professional | | $245.22 | $308.36 | $497.57 |