- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.72 / $80.80 / $243.06
| Professional | | $49.72 | $80.80 | $243.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.78 / $182.78 / $234.08
| Facility | | $182.78 | $182.78 | $234.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.19 / $82.65 / $193.82
| Professional | | $71.19 | $82.65 | $193.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.19 / $87.90 / $193.82
| Professional | | $71.19 | $87.90 | $193.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.32 / $175.67 / $236.16
| Professional | | $157.32 | $175.67 | $236.16 |