- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.17 / $122.06 / $199.39
| Professional | | $84.17 | $122.06 | $199.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.85 / $317.07 / $441.45
| Professional | | $178.85 | $317.07 | $441.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.86 / $253.21 / $448.18
| Professional | | $137.86 | $253.21 | $448.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.24 / $284.45 / $1,312.96
| Professional | | $165.24 | $284.45 | $1,312.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $267.07 / $423.30
| Professional | | $156.44 | $267.07 | $423.30 |