- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.03 / $358.03 / $358.03
| Facility | | $358.03 | $358.03 | $358.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $354.66 / $358.03
| Professional | | $283.73 | $354.66 | $358.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.03 / $358.03 / $358.03
| Facility | | $358.03 | $358.03 | $358.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.34 / $185.07 / $242.14
| Professional | | $174.34 | $185.07 | $242.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $81.36 / $205.63
| Professional | | $81.36 | $81.36 | $205.63 |