- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $467.74
| Professional | | $177.83 | $213.80 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $407.38
| Professional | | $190.55 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $234.42 / $1,412.54
| Professional | | $190.55 | $234.42 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $302.00
| Professional | | $190.55 | $229.09 | $302.00 |