- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.39 / $202.39 / $233.53
| Professional | | $202.39 | $202.39 | $233.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.53 / $335.53 / $335.53
| Professional | | $335.53 | $335.53 | $335.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.28 / $228.28 / $304.83
| Facility | | $228.28 | $228.28 | $304.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.64 / $228.28 / $243.36
| Professional | | $166.64 | $228.28 | $243.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.28 / $228.28 / $304.83
| Facility | | $228.28 | $228.28 | $304.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.64 / $228.28 / $243.36
| Professional | | $166.64 | $228.28 | $243.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.26 / $311.68 / $479.46
| Professional | | $182.26 | $311.68 | $479.46 |