- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.29 / $231.16 / $451.29
| Professional | | $79.29 | $231.16 | $451.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.14 / $304.14 / $1,025.61
| Professional | | $304.14 | $304.14 | $1,025.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.88 / $303.37 / $1,025.61
| Professional | | $110.88 | $303.37 | $1,025.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.38 / $318.54 / $1,025.61
| Professional | | $116.38 | $318.54 | $1,025.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.67 / $365.89 / $1,258.83
| Professional | | $267.67 | $365.89 | $1,258.83 |