- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $338.84 / $616.60
| Professional | | $281.84 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $416.87 / $575.44
| Professional | | $245.47 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $371.54 / $602.56
| Professional | | $338.84 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $549.54
| Professional | | $302.00 | $371.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $891.25
| Professional | | $281.84 | $371.54 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $602.56
| Professional | | $295.12 | $398.11 | $602.56 |