- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.47 / $250.71 / $330.10
| Professional | | $138.47 | $250.71 | $330.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.92 / $1,062.83 / $1,258.27
| Facility | | $786.92 | $1,062.83 | $1,258.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.53 / $363.53 / $503.31
| Professional | | $363.53 | $363.53 | $503.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.73 / $321.94 / $350.29
| Facility | | $315.73 | $321.94 | $350.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.48 / $315.73 / $350.29
| Professional | | $230.48 | $315.73 | $350.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.09 / $277.67 / $462.78
| Professional | | $189.09 | $277.67 | $462.78 |