- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.85 / $185.36 / $222.40
| Professional | | $163.85 | $185.36 | $222.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.39 / $318.75 / $329.59
| Professional | | $303.39 | $318.75 | $329.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.27 / $274.27 / $274.27
| Facility | | $274.27 | $274.27 | $274.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.13 / $274.27 / $274.27
| Professional | | $233.13 | $274.27 | $274.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.08 / $214.16 / $311.81
| Professional | | $169.08 | $214.16 | $311.81 |