- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.30 / $193.77 / $202.57
| Professional | | $74.30 | $193.77 | $202.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.58 / $448.97 / $1,505.25
| Professional | | $404.58 | $448.97 | $1,505.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.52 / $160.13 / $429.57
| Professional | | $58.52 | $160.13 | $429.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.64 / $191.70 / $429.57
| Professional | | $104.64 | $191.70 | $429.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.31 / $255.60 / $528.88
| Professional | | $164.31 | $255.60 | $528.88 |