- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.62 / $809.93 / $1,049.67
| Professional | | $450.62 | $809.93 | $1,049.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.63 / $168.63 / $168.63
| Facility | | $168.63 | $168.63 | $168.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.93 / $103.93 / $103.93
| Professional | | $103.93 | $103.93 | $103.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.40 / $833.40 / $1,317.74
| Facility | | $833.40 | $833.40 | $1,317.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.49 / $833.40 / $833.40
| Professional | | $106.49 | $833.40 | $833.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.72 / $668.58 / $1,309.07
| Professional | | $445.72 | $668.58 | $1,309.07 |