- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $201.19 / $331.69
| Professional | | $128.34 | $201.19 | $331.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.79 / $256.27 / $771.90
| Professional | | $208.79 | $256.27 | $771.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.24 / $220.14 / $590.83
| Professional | | $137.24 | $220.14 | $590.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.40 / $282.83 / $590.83
| Professional | | $173.40 | $282.83 | $590.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.97 / $238.67 / $839.17
| Professional | | $208.97 | $238.67 | $839.17 |