- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.24 / $170.84 / $193.72
| Professional | | $137.24 | $170.84 | $193.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.44 / $145.44 / $178.40
| Professional | | $145.44 | $145.44 | $178.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.40 / $178.40 / $178.40
| Professional | | $178.40 | $178.40 | $178.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.47 / $160.47 / $160.47
| Facility | | $160.47 | $160.47 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.57 / $210.44 / $256.19
| Professional | | $176.57 | $210.44 | $256.19 |