- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.93 / $306.39 / $333.83
| Professional | | $245.93 | $306.39 | $333.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.80 / $1,074.83 / $1,272.49
| Facility | | $795.80 | $1,074.83 | $1,272.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.49 / $367.64 / $509.00
| Professional | | $312.49 | $367.64 | $509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.57 / $361.45 / $361.45
| Facility | | $325.57 | $361.45 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $361.45 / $361.45
| Professional | | $263.86 | $361.45 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.70 / $296.91 / $468.00
| Professional | | $215.70 | $296.91 | $468.00 |