- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.88 / $429.32 / $481.19
| Professional | | $178.88 | $429.32 | $481.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $350.00
| Professional | | $350.00 | $350.00 | $350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.92 / $270.32 / $374.70
| Professional | | $174.92 | $270.32 | $374.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.40 / $240.88 / $482.72
| Professional | | $174.40 | $240.88 | $482.72 |