- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.74 / $251.38 / $431.42
| Professional | | $163.74 | $251.38 | $431.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.14 / $321.93 / $923.08
| Professional | | $265.14 | $321.93 | $923.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.84 / $265.81 / $709.78
| Professional | | $174.84 | $265.81 | $709.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.16 / $360.28 / $709.78
| Professional | | $225.16 | $360.28 | $709.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.73 / $351.23 / $577.89
| Professional | | $254.73 | $351.23 | $577.89 |