- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $977.24
| Professional | | $162.18 | $275.42 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $331.13 / $524.81
| Professional | | $199.53 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $512.86 / $812.83
| Professional | | $281.84 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $2,041.74
| Professional | | $309.03 | $524.81 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $794.33
| Professional | | $389.05 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $851.14
| Professional | | $389.05 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $371.54 / $645.65
| Professional | | $213.80 | $371.54 | $645.65 |