- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.04 / $287.25 / $358.42
| Professional | | $264.04 | $287.25 | $358.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.41 / $1,154.02 / $1,366.22
| Facility | | $854.41 | $1,154.02 | $1,366.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.94 / $317.58 / $531.14
| Professional | | $269.94 | $317.58 | $531.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.85 / $298.85 / $349.54
| Facility | | $298.85 | $298.85 | $349.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.16 / $298.85 / $298.85
| Professional | | $218.16 | $298.85 | $298.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.48 / $345.12 / $502.48
| Professional | | $272.48 | $345.12 | $502.48 |