- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.65 / $868.78 / $868.78
| Professional | | $118.65 | $868.78 | $868.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.12 / $271.14 / $271.14
| Facility | | $141.12 | $271.14 | $271.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.12 / $271.14 / $271.14
| Professional | | $141.12 | $271.14 | $271.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.91 / $258.24 / $271.14
| Facility | | $125.91 | $258.24 | $271.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.08 / $203.52 / $271.36
| Professional | | $194.08 | $203.52 | $271.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.83 / $112.67 / $172.41
| Professional | | $101.83 | $112.67 | $172.41 |