- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.96 / $207.46 / $297.95
| Professional | | $124.96 | $207.46 | $297.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.03 / $232.63 / $420.44
| Professional | | $142.03 | $232.63 | $420.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.12 / $243.57 / $426.29
| Professional | | $150.12 | $243.57 | $426.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.96 / $1,646.24 / $1,930.80
| Professional | | $1,044.96 | $1,646.24 | $1,930.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.65 / $317.75 / $506.00
| Professional | | $214.65 | $317.75 | $506.00 |