- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.81 / $210.09 / $906.11
| Professional | | $159.81 | $210.09 | $906.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.75 / $356.75 / $808.75
| Professional | | $356.75 | $356.75 | $808.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.42 / $293.26 / $808.75
| Professional | | $192.42 | $293.26 | $808.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.07 / $364.34 / $808.75
| Professional | | $239.07 | $364.34 | $808.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.77 / $312.73 / $992.66
| Professional | | $263.77 | $312.73 | $992.66 |