- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.58 / $178.99 / $226.56
| Professional | | $118.58 | $178.99 | $226.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.43 / $161.68 / $241.97
| Professional | | $137.43 | $161.68 | $241.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.96 / $242.59 / $373.59
| Professional | | $153.96 | $242.59 | $373.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.63 / $239.08 / $424.34
| Professional | | $156.63 | $239.08 | $424.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.09 / $178.99 / $256.14
| Professional | | $121.09 | $178.99 | $256.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.86 / $253.90 / $394.94
| Professional | | $178.86 | $253.90 | $394.94 |