- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.60 / $367.74 / $459.67
| Professional | | $297.60 | $367.74 | $459.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.47 / $304.70 / $360.87
| Facility | | $176.47 | $304.70 | $360.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.85 / $808.85 / $808.85
| Professional | | $808.85 | $808.85 | $808.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.00 / $282.00 / $282.00
| Facility | | $282.00 | $282.00 | $282.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.00 / $288.00 / $350.41
| Professional | | $258.00 | $288.00 | $350.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.46 / $176.46 / $212.52
| Professional | | $176.46 | $176.46 | $212.52 |