- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.92 / $345.92 / $432.40
| Professional | | $345.92 | $345.92 | $432.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Professional | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $92.67 / $104.60
| Facility | | $55.00 | $92.67 | $104.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.85 / $94.25 / $94.25
| Professional | | $90.85 | $94.25 | $94.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.85 / $94.25 / $94.25
| Professional | | $90.85 | $94.25 | $94.25 |