- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.29 / $203.78 / $632.00
| Professional | | $96.29 | $203.78 | $632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.44 / $248.06 / $479.26
| Professional | | $210.44 | $248.06 | $479.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.88 / $196.85 / $479.26
| Professional | | $152.88 | $196.85 | $479.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.93 / $196.85 / $378.97
| Professional | | $152.93 | $196.85 | $378.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.34 / $214.77 / $588.24
| Professional | | $149.34 | $214.77 | $588.24 |