- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.66 / $287.66 / $287.66
| Professional | | $287.66 | $287.66 | $287.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.03 / $110.03 / $129.44
| Professional | | $110.03 | $110.03 | $129.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.28 / $274.52 / $323.87
| Facility | | $221.28 | $274.52 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.52 / $154.90 / $247.46
| Professional | | $147.52 | $154.90 | $247.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.85 / $132.77 / $287.66
| Professional | | $112.85 | $132.77 | $287.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.17 / $259.38 / $289.69
| Professional | | $253.17 | $259.38 | $289.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $125.37 / $206.53
| Professional | | $88.51 | $125.37 | $206.53 |