- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.41 / $184.69 / $464.19
| Professional | | $131.41 | $184.69 | $464.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.86 / $200.86 / $200.86
| Professional | | $200.86 | $200.86 | $200.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.50 / $193.72 / $312.06
| Professional | | $138.50 | $193.72 | $312.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.50 / $214.06 / $356.70
| Professional | | $138.50 | $214.06 | $356.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.64 / $233.04 / $276.25
| Professional | | $185.64 | $233.04 | $276.25 |