- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.93 / $207.93 / $283.41
| Professional | | $154.93 | $207.93 | $283.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.41 / $216.52 / $307.12
| Professional | | $175.41 | $216.52 | $307.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.71 / $306.52 / $442.76
| Professional | | $200.71 | $306.52 | $442.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.09 / $279.06 / $495.30
| Professional | | $199.09 | $279.06 | $495.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.93 / $207.93 / $283.41
| Professional | | $154.93 | $207.93 | $283.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.88 / $299.98 / $457.65
| Professional | | $206.88 | $299.98 | $457.65 |