- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $457.09
| Professional | | $138.04 | $208.93 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $323.59 / $549.54
| Professional | | $173.78 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $724.44
| Professional | | $229.09 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $398.11 / $776.25
| Professional | | $213.80 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $741.31
| Professional | | $223.87 | $398.11 | $741.31 |