- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.86 / $235.68 / $429.79
| Professional | | $159.86 | $235.68 | $429.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.89 / $380.96 / $538.15
| Professional | | $171.89 | $380.96 | $538.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.53 / $290.00 / $538.04
| Professional | | $183.53 | $290.00 | $538.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.55 / $342.14 / $609.51
| Professional | | $264.55 | $342.14 | $609.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.06 / $346.30 / $829.44
| Professional | | $191.06 | $346.30 | $829.44 |