- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.16 / $285.91 / $443.75
| Professional | | $188.16 | $285.91 | $443.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.97 / $348.74 / $575.88
| Professional | | $217.97 | $348.74 | $575.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.23 / $322.62 / $549.85
| Professional | | $205.23 | $322.62 | $549.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.60 / $2,165.28 / $2,513.69
| Professional | | $1,437.60 | $2,165.28 | $2,513.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.69 / $376.21 / $671.99
| Professional | | $258.69 | $376.21 | $671.99 |