- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.79 / $203.35 / $254.18
| Professional | | $184.79 | $203.35 | $254.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.12 / $266.60 / $266.60
| Facility | | $130.12 | $266.60 | $266.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.58 / $760.58 / $760.58
| Professional | | $760.58 | $760.58 | $760.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.33 / $184.00 / $184.00
| Facility | | $149.33 | $184.00 | $184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.08 / $175.00 / $200.68
| Professional | | $106.08 | $175.00 | $200.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.00 / $171.74 / $174.61
| Professional | | $127.00 | $171.74 | $174.61 |