- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.90 / $192.30 / $344.85
| Professional | | $154.90 | $192.30 | $344.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.97 / $265.97 / $265.97
| Facility | | $265.97 | $265.97 | $265.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $226.07 / $565.78
| Professional | | $226.07 | $226.07 | $565.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.12 / $359.12 / $462.00
| Professional | | $359.12 | $359.12 | $462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.94 / $274.94 / $274.94
| Professional | | $274.94 | $274.94 | $274.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.95 / $235.34 / $374.96
| Professional | | $188.95 | $235.34 | $374.96 |