- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.89 / $226.74 / $253.82
| Professional | | $171.89 | $226.74 | $253.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.68 / $284.29 / $421.38
| Professional | | $219.68 | $284.29 | $421.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.90 / $328.21 / $458.07
| Professional | | $231.90 | $328.21 | $458.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.04 / $306.64 / $470.42
| Professional | | $265.04 | $306.64 | $470.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.89 / $253.82 / $316.51
| Professional | | $171.89 | $253.82 | $316.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.63 / $311.39 / $417.04
| Professional | | $212.63 | $311.39 | $417.04 |