- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.17 / $149.80 / $348.45
| Professional | | $119.17 | $149.80 | $348.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.31 / $219.31 / $219.31
| Professional | | $219.31 | $219.31 | $219.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.00 / $281.00 / $281.00
| Professional | | $281.00 | $281.00 | $281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.88 / $211.87 / $306.89
| Professional | | $143.88 | $211.87 | $306.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.36 / $181.25 / $367.08
| Professional | | $144.36 | $181.25 | $367.08 |