- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.90 / $202.11 / $204.67
| Professional | | $148.90 | $202.11 | $204.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.70 / $289.64 / $299.51
| Professional | | $275.70 | $289.64 | $299.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.83 / $302.83 / $302.83
| Facility | | $302.83 | $302.83 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.41 / $302.83 / $302.83
| Professional | | $257.41 | $302.83 | $302.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.66 / $224.66 / $224.66
| Facility | | $224.66 | $224.66 | $224.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.03 / $194.62 / $283.35
| Professional | | $160.03 | $194.62 | $283.35 |