- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.55 / $370.53 / $1,258.99
| Professional | | $238.55 | $370.53 | $1,258.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.41 / $660.61 / $1,351.96
| Professional | | $560.41 | $660.61 | $1,351.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.61 / $409.43 / $646.10
| Professional | | $255.61 | $409.43 | $646.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.61 / $398.95 / $646.10
| Professional | | $255.61 | $398.95 | $646.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.90 / $492.72 / $1,525.36
| Professional | | $439.90 | $492.72 | $1,525.36 |