- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.62 / $235.67 / $268.55
| Professional | | $197.62 | $235.67 | $268.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.98 / $204.33 / $204.33
| Professional | | $187.98 | $204.33 | $204.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.16 / $238.16 / $378.27
| Facility | | $238.16 | $238.16 | $378.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.44 / $238.16 / $387.72
| Professional | | $202.44 | $238.16 | $387.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.61 / $156.46 / $260.33
| Professional | | $109.61 | $156.46 | $260.33 |