- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $363.08
| Professional | | $125.89 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $741.31
| Professional | | $239.88 | $239.88 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $741.31
| Professional | | $158.49 | $251.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $512.86
| Professional | | $213.80 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $467.74
| Professional | | $144.54 | $213.80 | $467.74 |