- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $575.44
| Professional | | $173.78 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $309.03 / $436.52
| Professional | | $275.42 | $309.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $436.52
| Professional | | $186.21 | $269.15 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $501.19
| Professional | | $302.00 | $457.09 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $295.12 / $549.54
| Professional | | $79.43 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $501.19
| Professional | | $257.04 | $338.84 | $501.19 |