- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.92 / $774.92 / $968.66
| Professional | | $774.92 | $774.92 | $968.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.77 / $490.77 / $490.77
| Facility | | $490.77 | $490.77 | $490.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.00 / $1,195.82 / $1,195.82
| Professional | | $124.00 | $1,195.82 | $1,195.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.84 / $225.00 / $261.76
| Facility | | $158.84 | $225.00 | $261.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.16 / $243.79 / $292.33
| Professional | | $138.16 | $243.79 | $292.33 |