- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $202.69 / $336.37
| Professional | | $182.45 | $202.69 | $336.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.54 / $206.54 / $206.54
| Facility | | $206.54 | $206.54 | $206.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.12 / $215.96 / $359.93
| Facility | | $172.12 | $215.96 | $359.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $182.45 / $182.45
| Professional | | $182.45 | $182.45 | $182.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.12 / $215.96 / $359.93
| Facility | | $172.12 | $215.96 | $359.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $182.45 / $182.45
| Professional | | $182.45 | $182.45 | $182.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $182.45 / $280.66
| Professional | | $182.45 | $182.45 | $280.66 |