- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.46 / $213.93 / $286.52
| Professional | | $166.46 | $213.93 | $286.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.78 / $243.78 / $326.36
| Facility | | $243.78 | $243.78 | $326.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.21 / $243.78 / $326.36
| Professional | | $207.21 | $243.78 | $326.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.78 / $243.78 / $326.36
| Facility | | $243.78 | $243.78 | $326.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.78 / $243.78 / $326.36
| Professional | | $243.78 | $243.78 | $326.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.47 / $314.87 / $443.67
| Professional | | $125.47 | $314.87 | $443.67 |