- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.76 / $319.51 / $319.51
| Facility | | $259.76 | $319.51 | $319.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.19 / $259.76 / $319.51
| Professional | | $215.19 | $259.76 | $319.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $305.64 / $431.71
| Professional | | $226.01 | $305.64 | $431.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.10 / $287.10 / $287.10
| Professional | | $287.10 | $287.10 | $287.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.21 / $335.49 / $729.93
| Facility | | $239.21 | $335.49 | $729.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.50 / $1,712.50 / $1,712.50
| Professional | | $1,712.50 | $1,712.50 | $1,712.50 |