- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.74 / $291.91 / $656.69
| Professional | | $120.74 | $291.91 | $656.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.20 / $224.41 / $448.80
| Professional | | $164.20 | $224.41 | $448.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $286.56 / $511.72
| Professional | | $198.02 | $286.56 | $511.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $78.00 / $455.40
| Professional | | $30.00 | $78.00 | $455.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.88 / $247.47 / $532.53
| Professional | | $227.88 | $247.47 | $532.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.12 / $323.10 / $509.77
| Professional | | $244.12 | $323.10 | $509.77 |