- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.80 / $231.80 / $267.47
| Professional | | $231.80 | $231.80 | $267.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.64 / $274.64 / $349.13
| Facility | | $274.64 | $274.64 | $349.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.49 / $274.64 / $292.80
| Professional | | $200.49 | $274.64 | $292.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.64 / $274.64 / $349.13
| Facility | | $274.64 | $274.64 | $349.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.49 / $274.64 / $292.80
| Professional | | $200.49 | $274.64 | $292.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.97 / $281.38 / $549.15
| Professional | | $157.97 | $281.38 | $549.15 |