- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.56 / $195.31 / $257.45
| Professional | | $177.56 | $195.31 | $257.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.96 / $150.62 / $224.28
| Facility | | $141.96 | $150.62 | $224.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.28 / $224.28 / $360.64
| Facility | | $224.28 | $224.28 | $360.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.44 / $174.44 / $174.44
| Professional | | $174.44 | $174.44 | $174.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.28 / $224.28 / $360.64
| Facility | | $224.28 | $224.28 | $360.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.44 / $174.44 / $174.44
| Professional | | $174.44 | $174.44 | $174.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.21 / $155.75 / $186.90
| Professional | | $144.21 | $155.75 | $186.90 |