- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.36 / $220.36 / $385.91
| Professional | | $220.36 | $220.36 | $385.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.39 / $430.39 / $430.39
| Facility | | $430.39 | $430.39 | $430.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.39 / $430.39 / $430.39
| Professional | | $430.39 | $430.39 | $430.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.70 / $315.70 / $514.05
| Facility | | $315.70 | $315.70 | $514.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.47 / $230.47 / $315.70
| Professional | | $230.47 | $230.47 | $315.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.72 / $219.87 / $338.81
| Professional | | $198.72 | $219.87 | $338.81 |