- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.24 / $324.24 / $405.30
| Professional | | $324.24 | $324.24 | $405.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.01 / $402.29 / $822.62
| Facility | | $155.01 | $402.29 | $822.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.08 / $609.10 / $1,577.03
| Professional | | $328.08 | $609.10 | $1,577.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $563.00 / $563.00
| Facility | | $563.00 | $563.00 | $563.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.08 / $563.00 / $609.10
| Professional | | $328.08 | $563.00 | $609.10 |