- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $467.74
| Professional | | $154.88 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $724.44
| Professional | | $173.78 | $281.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $562.34
| Professional | | $162.18 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $331.13 / $457.09
| Professional | | $269.15 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $602.56
| Professional | | $177.83 | $309.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $724.44
| Professional | | $173.78 | $281.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $602.56
| Professional | | $177.83 | $295.12 | $602.56 |