- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.36 / $360.01 / $461.30
| Professional | | $321.36 | $360.01 | $461.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.45 / $462.45 / $462.45
| Facility | | $462.45 | $462.45 | $462.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.45 / $462.45 / $462.45
| Professional | | $462.45 | $462.45 | $462.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.50 / $292.50 / $567.42
| Facility | | $292.50 | $292.50 | $567.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.63 / $292.50 / $418.36
| Professional | | $248.63 | $292.50 | $418.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.34 / $273.04 / $484.86
| Professional | | $167.34 | $273.04 | $484.86 |