- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.43 / $219.97 / $442.90
| Professional | | $158.43 | $219.97 | $442.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.19 / $196.19 / $272.10
| Professional | | $196.19 | $196.19 | $272.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.84 / $275.04 / $684.57
| Professional | | $164.84 | $275.04 | $684.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.30 / $330.39 / $625.05
| Professional | | $255.30 | $330.39 | $625.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.84 / $257.56 / $626.83
| Professional | | $177.84 | $257.56 | $626.83 |