- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.78 / $155.55 / $363.59
| Professional | | $60.78 | $155.55 | $363.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.31 / $262.31 / $262.31
| Professional | | $262.31 | $262.31 | $262.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.75 / $156.04 / $569.55
| Professional | | $84.75 | $156.04 | $569.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.38 / $275.88 / $569.55
| Professional | | $91.38 | $275.88 | $569.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.41 / $238.57 / $699.08
| Professional | | $209.41 | $238.57 | $699.08 |