- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.29 / $257.32 / $257.32
| Professional | | $215.29 | $257.32 | $257.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.32 / $272.14 / $372.60
| Professional | | $237.32 | $272.14 | $372.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.26 / $324.11 / $444.11
| Professional | | $255.26 | $324.11 | $444.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.00 / $279.47 / $428.73
| Professional | | $217.00 | $279.47 | $428.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.29 / $257.32 / $257.32
| Professional | | $215.29 | $257.32 | $257.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.48 / $316.93 / $391.03
| Professional | | $269.48 | $316.93 | $391.03 |