- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.54 / $173.70 / $173.70
| Professional | | $127.54 | $173.70 | $173.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.27 / $192.27 / $198.04
| Professional | | $192.27 | $192.27 | $198.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.31 / $172.23 / $527.66
| Professional | | $149.31 | $172.23 | $527.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.15 / $403.17 / $403.17
| Professional | | $173.15 | $403.17 | $403.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.97 / $194.57 / $497.01
| Professional | | $138.97 | $194.57 | $497.01 |