- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.13 / $224.45 / $284.85
| Professional | | $185.13 | $224.45 | $284.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.95 / $220.64 / $660.00
| Professional | | $204.95 | $220.64 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.42 / $253.92 / $667.66
| Professional | | $186.42 | $253.92 | $667.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.64 / $641.26 / $641.26
| Professional | | $286.64 | $641.26 | $641.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.60 / $279.55 / $741.02
| Professional | | $189.60 | $279.55 | $741.02 |