- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.16 / $275.95 / $429.26
| Professional | | $188.16 | $275.95 | $429.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.05 / $285.75 / $483.15
| Professional | | $194.05 | $285.75 | $483.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.35 / $300.87 / $488.26
| Professional | | $192.35 | $300.87 | $488.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $275.64 / $425.00
| Professional | | $104.00 | $275.64 | $425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.84 / $266.76 / $333.86
| Professional | | $177.84 | $266.76 | $333.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.91 / $332.98 / $564.48
| Professional | | $243.91 | $332.98 | $564.48 |