- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.87 / $235.13 / $389.27
| Professional | | $154.87 | $235.13 | $389.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.17 / $250.78 / $363.55
| Professional | | $213.17 | $250.78 | $363.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.97 / $363.90 / $642.94
| Professional | | $227.97 | $363.90 | $642.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.43 / $413.02 / $663.06
| Professional | | $237.43 | $413.02 | $663.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.87 / $235.13 / $389.27
| Professional | | $154.87 | $235.13 | $389.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.47 / $342.56 / $658.98
| Professional | | $251.47 | $342.56 | $658.98 |