- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.34 / $179.34 / $932.51
| Professional | | $179.34 | $179.34 | $932.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.34 / $196.34 / $196.34
| Professional | | $196.34 | $196.34 | $196.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.15 / $218.55 / $606.66
| Professional | | $155.15 | $218.55 | $606.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.01 / $218.55 / $606.66
| Professional | | $200.01 | $218.55 | $606.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.17 / $251.26 / $744.62
| Professional | | $224.17 | $251.26 | $744.62 |