- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.30 / $202.31 / $903.87
| Professional | | $171.30 | $202.31 | $903.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.66 / $148.33 / $385.64
| Professional | | $95.66 | $148.33 | $385.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.36 / $602.83 / $722.26
| Professional | | $570.36 | $602.83 | $722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $196.42
| Professional | | $32.34 | $32.34 | $196.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.69 / $284.63 / $454.72
| Professional | | $155.69 | $284.63 | $454.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.80 / $279.83 / $370.19
| Professional | | $186.80 | $279.83 | $370.19 |