- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.78 / $253.78 / $370.57
| Professional | | $198.78 | $253.78 | $370.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.06 / $191.41 / $327.55
| Professional | | $52.06 | $191.41 | $327.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.61 / $293.58 / $470.37
| Professional | | $198.61 | $293.58 | $470.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.78 / $336.22 / $499.34
| Professional | | $253.78 | $336.22 | $499.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.79 / $232.76 / $369.69
| Professional | | $30.79 | $232.76 | $369.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.84 / $440.87 / $563.57
| Professional | | $356.84 | $440.87 | $563.57 |