- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.94 / $155.40 / $155.40
| Professional | | $129.94 | $155.40 | $155.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.50 / $628.50 / $628.50
| Professional | | $628.50 | $628.50 | $628.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.72 / $218.37 / $394.77
| Professional | | $163.72 | $218.37 | $394.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.55 / $219.90 / $628.50
| Professional | | $174.55 | $219.90 | $628.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.65 / $176.93 / $514.35
| Professional | | $136.65 | $176.93 | $514.35 |