- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.16 / $202.52 / $269.95
| Professional | | $138.16 | $202.52 | $269.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.39 / $184.16 / $306.85
| Professional | | $118.39 | $184.16 | $306.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.13 / $219.52 / $306.85
| Professional | | $159.13 | $219.52 | $306.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.29 / $248.54 / $480.72
| Professional | | $145.29 | $248.54 | $480.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.40 / $317.55 / $531.75
| Professional | | $230.40 | $317.55 | $531.75 |