- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.37 / $227.05 / $523.41
| Professional | | $143.37 | $227.05 | $523.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.37 / $262.13 / $485.79
| Professional | | $176.37 | $262.13 | $485.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $165.45 / $229.06
| Professional | | $25.65 | $165.45 | $229.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.81 / $316.54 / $430.52
| Professional | | $210.81 | $316.54 | $430.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.45 / $280.79 / $465.30
| Professional | | $204.45 | $280.79 | $465.30 |