- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.57 / $209.57 / $367.19
| Professional | | $209.57 | $209.57 | $367.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.98 / $277.76 / $442.85
| Professional | | $242.98 | $277.76 | $442.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.82 / $314.18 / $450.11
| Professional | | $261.82 | $314.18 | $450.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.77 / $302.36 / $463.83
| Professional | | $234.77 | $302.36 | $463.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.57 / $209.57 / $367.19
| Professional | | $209.57 | $209.57 | $367.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.27 / $302.36 / $418.57
| Professional | | $234.27 | $302.36 | $418.57 |