- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.83 / $232.49 / $436.36
| Professional | | $172.83 | $232.49 | $436.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.78 / $242.09 / $352.18
| Professional | | $205.78 | $242.09 | $352.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.52 / $375.16 / $639.66
| Professional | | $224.52 | $375.16 | $639.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.01 / $406.84 / $653.14
| Professional | | $230.01 | $406.84 | $653.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.83 / $232.49 / $436.36
| Professional | | $172.83 | $232.49 | $436.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.01 / $453.80 / $674.79
| Professional | | $326.01 | $453.80 | $674.79 |