- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.58 / $472.45 / $757.60
| Professional | | $76.58 | $472.45 | $757.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.78 / $206.10 / $1,548.61
| Professional | | $159.78 | $206.10 | $1,548.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.01 / $242.62 / $1,991.60
| Professional | | $116.01 | $242.62 | $1,991.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.13 / $1,483.16 / $1,994.28
| Professional | | $761.13 | $1,483.16 | $1,994.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.13 / $1,579.72 / $1,994.28
| Professional | | $761.13 | $1,579.72 | $1,994.28 |