- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.85 / $259.02 / $323.79
| Professional | | $204.85 | $259.02 | $323.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.85 / $365.20 / $465.63
| Facility | | $232.85 | $365.20 | $465.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.69 / $255.01 / $710.30
| Professional | | $66.69 | $255.01 | $710.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.16 / $185.42 / $312.58
| Facility | | $171.16 | $185.42 | $312.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.16 / $236.71 / $312.58
| Professional | | $171.16 | $236.71 | $312.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.96 / $343.64 / $391.83
| Professional | | $203.96 | $343.64 | $391.83 |