- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.31 / $176.11 / $506.22
| Professional | | $97.31 | $176.11 | $506.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.76 / $461.51 / $668.81
| Professional | | $411.76 | $461.51 | $668.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.78 / $167.36 / $315.80
| Professional | | $102.78 | $167.36 | $315.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.78 / $181.85 / $312.17
| Professional | | $102.78 | $181.85 | $312.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.60 / $244.87 / $733.27
| Professional | | $207.60 | $244.87 | $733.27 |