- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.53 / $163.49 / $187.27
| Professional | | $149.53 | $163.49 | $187.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.31 / $253.80 / $543.02
| Professional | | $215.31 | $253.80 | $543.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.50 / $229.67 / $349.13
| Professional | | $154.50 | $229.67 | $349.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.95 / $229.67 / $349.13
| Professional | | $166.95 | $229.67 | $349.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.54 / $219.28 / $637.47
| Professional | | $178.54 | $219.28 | $637.47 |