- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.73 / $257.74 / $284.89
| Professional | | $180.73 | $257.74 | $284.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.85 / $234.62 / $234.62
| Professional | | $215.85 | $234.62 | $234.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.50 / $240.50 / $324.72
| Facility | | $240.50 | $240.50 | $324.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.88 / $240.50 / $386.25
| Professional | | $26.88 | $240.50 | $386.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.79 / $144.85 / $260.91
| Professional | | $98.79 | $144.85 | $260.91 |