- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.57 / $260.57 / $272.42
| Professional | | $260.57 | $260.57 | $272.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.14 / $270.76 / $404.40
| Professional | | $230.14 | $270.76 | $404.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.41 / $379.53 / $487.42
| Professional | | $271.41 | $379.53 | $487.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.45 / $299.02 / $561.04
| Professional | | $258.45 | $299.02 | $561.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.57 / $260.57 / $347.50
| Professional | | $260.57 | $260.57 | $347.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.45 / $315.61 / $434.17
| Professional | | $258.45 | $315.61 | $434.17 |