- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $616.60
| Professional | | $295.12 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $1,096.48
| Facility | | $380.19 | $380.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $794.33
| Professional | | $275.42 | $275.42 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $831.76
| Facility | | $204.17 | $354.81 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $457.09
| Professional | | $204.17 | $302.00 | $457.09 |