- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.07 / $225.68 / $302.25
| Professional | | $178.07 | $225.68 | $302.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.08 / $361.08 / $361.08
| Professional | | $361.08 | $361.08 | $361.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.50 / $256.50 / $386.04
| Facility | | $256.50 | $256.50 | $386.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $256.50 / $386.04
| Professional | | $218.03 | $256.50 | $386.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.50 / $256.50 / $386.04
| Facility | | $256.50 | $256.50 | $386.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.50 / $256.50 / $386.04
| Professional | | $256.50 | $256.50 | $386.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.63 / $297.77 / $338.26
| Professional | | $44.63 | $297.77 | $338.26 |