- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.95 / $373.67 / $1,937.68
| Professional | | $210.95 | $373.67 | $1,937.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.39 / $504.39 / $504.39
| Facility | | $504.39 | $504.39 | $504.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.35 / $340.85 / $677.08
| Professional | | $143.35 | $340.85 | $677.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.39 / $504.39 / $504.39
| Facility | | $504.39 | $504.39 | $504.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.35 / $340.85 / $677.08
| Professional | | $143.35 | $340.85 | $677.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.63 / $301.35 / $1,356.08
| Professional | | $131.63 | $301.35 | $1,356.08 |