- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.57 / $269.57 / $311.05
| Professional | | $269.57 | $269.57 | $311.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.52 / $274.52 / $406.02
| Facility | | $274.52 | $274.52 | $406.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $274.52 / $292.66
| Professional | | $200.41 | $274.52 | $292.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.52 / $274.52 / $406.02
| Facility | | $274.52 | $274.52 | $406.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $274.52 / $292.66
| Professional | | $200.41 | $274.52 | $292.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.73 / $327.23 / $638.61
| Professional | | $183.73 | $327.23 | $638.61 |