- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.96 / $278.39 / $302.16
| Professional | | $230.96 | $278.39 | $302.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.61 / $301.75 / $301.75
| Professional | | $277.61 | $301.75 | $301.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.86 / $28.86 / $28.86
| Facility | | $28.86 | $28.86 | $28.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.40 / $193.40 / $258.98
| Facility | | $193.40 | $193.40 | $258.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.77 / $193.40 / $326.25
| Professional | | $23.77 | $193.40 | $326.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.25 / $44.88 / $250.68
| Professional | | $14.25 | $44.88 | $250.68 |