- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.44 / $325.41 / $687.65
| Professional | | $204.44 | $325.41 | $687.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.69 / $402.69 / $563.48
| Professional | | $226.69 | $402.69 | $563.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.23 / $529.05 / $765.69
| Professional | | $319.23 | $529.05 | $765.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.74 / $493.33 / $610.26
| Professional | | $264.74 | $493.33 | $610.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.06 / $578.54 / $907.71
| Professional | | $297.06 | $578.54 | $907.71 |