- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.01 / $187.72 / $229.96
| Professional | | $156.01 | $187.72 | $229.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.55 / $258.24 / $382.71
| Professional | | $199.55 | $258.24 | $382.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.37 / $297.36 / $415.54
| Professional | | $210.37 | $297.36 | $415.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $278.51 / $427.25
| Professional | | $240.72 | $278.51 | $427.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.01 / $229.96 / $278.14
| Professional | | $156.01 | $229.96 | $278.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.75 / $251.76 / $379.60
| Professional | | $177.75 | $251.76 | $379.60 |