- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.93 / $352.21 / $401.41
| Professional | | $253.93 | $352.21 | $401.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.69 / $534.79 / $1,246.61
| Professional | | $453.69 | $534.79 | $1,246.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.81 / $521.08 / $754.86
| Professional | | $333.81 | $521.08 | $754.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.84 / $497.81 / $754.86
| Professional | | $403.84 | $497.81 | $754.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.22 / $474.12 / $1,378.31
| Professional | | $393.22 | $474.12 | $1,378.31 |