- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.39 / $815.23 / $922.04
| Professional | | $294.39 | $815.23 | $922.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $507.00 / $641.21
| Facility | | $507.00 | $507.00 | $641.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.40 / $863.69 / $1,640.25
| Professional | | $656.40 | $863.69 | $1,640.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $36.00 / $41.00
| Facility | | $36.00 | $36.00 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.46 / $475.48 / $819.84
| Professional | | $336.46 | $475.48 | $819.84 |