- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.45 / $345.80 / $420.42
| Professional | | $257.45 | $345.80 | $420.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.06 / $311.60 / $531.32
| Professional | | $186.06 | $311.60 | $531.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.80 / $200.77 / $285.45
| Professional | | $26.80 | $200.77 | $285.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.77 / $410.36 / $558.28
| Professional | | $276.77 | $410.36 | $558.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.95 / $317.85 / $510.95
| Professional | | $268.95 | $317.85 | $510.95 |