- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.30 / $311.42 / $457.98
| Professional | | $186.30 | $311.42 | $457.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.90 / $366.11 / $549.69
| Professional | | $252.90 | $366.11 | $549.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.57 / $412.70 / $738.57
| Professional | | $233.57 | $412.70 | $738.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.81 / $412.61 / $694.67
| Professional | | $263.81 | $412.61 | $694.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.30 / $276.33 / $457.98
| Professional | | $186.30 | $276.33 | $457.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.72 / $581.63 / $732.34
| Professional | | $364.72 | $581.63 | $732.34 |