- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.48 / $318.48 / $363.49
| Professional | | $290.48 | $318.48 | $363.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.64 / $243.64 / $243.64
| Professional | | $243.64 | $243.64 | $243.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $443.25 / $554.05
| Professional | | $289.52 | $443.25 | $554.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.48 / $318.48 / $417.41
| Facility | | $290.48 | $318.48 | $417.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.13 / $325.13 / $325.13
| Professional | | $325.13 | $325.13 | $325.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.00 / $365.59 / $629.11
| Professional | | $289.00 | $365.59 | $629.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.57 / $1,988.64 / $1,988.64
| Facility | | $696.57 | $1,988.64 | $1,988.64 |