- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.72 / $229.72 / $402.30
| Professional | | $229.72 | $229.72 | $402.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.67 / $448.67 / $448.67
| Facility | | $448.67 | $448.67 | $448.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.67 / $448.67 / $448.67
| Professional | | $448.67 | $448.67 | $448.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.84 / $335.84 / $554.94
| Facility | | $335.84 | $335.84 | $554.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.16 / $245.16 / $442.06
| Professional | | $245.16 | $245.16 | $442.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.75 / $222.12 / $342.28
| Professional | | $200.75 | $222.12 | $342.28 |