- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.33 / $291.33 / $336.16
| Professional | | $291.33 | $291.33 | $336.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.20 / $386.20 / $386.20
| Facility | | $386.20 | $386.20 | $386.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.93 / $281.93 / $281.93
| Professional | | $281.93 | $281.93 | $281.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.20 / $386.20 / $386.20
| Facility | | $386.20 | $386.20 | $386.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.93 / $281.93 / $281.93
| Professional | | $281.93 | $281.93 | $281.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.51 / $496.41 / $690.18
| Professional | | $206.51 | $496.41 | $690.18 |