- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.57 / $492.57 / $615.71
| Professional | | $492.57 | $492.57 | $615.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.47 / $132.28 / $670.71
| Facility | | $128.47 | $132.28 | $670.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $852.67 / $852.67
| Professional | | $132.00 | $852.67 | $852.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.00 / $252.00 / $252.00
| Facility | | $252.00 | $252.00 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $254.28 / $455.65
| Professional | | $132.00 | $254.28 | $455.65 |