- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.75 / $264.70 / $348.52
| Professional | | $256.75 | $264.70 | $348.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.80 / $1,122.15 / $1,328.49
| Facility | | $830.80 | $1,122.15 | $1,328.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.49 / $308.81 / $516.47
| Professional | | $262.49 | $308.81 | $516.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.70 / $315.70 / $339.89
| Facility | | $315.70 | $315.70 | $339.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.47 / $315.70 / $315.70
| Professional | | $230.47 | $315.70 | $315.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.54 / $330.87 / $488.60
| Professional | | $229.54 | $330.87 | $488.60 |