- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.46 / $331.42 / $331.42
| Professional | | $209.46 | $331.42 | $331.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.68 / $491.25 / $614.05
| Professional | | $354.68 | $491.25 | $614.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.43 / $331.42 / $397.70
| Facility | | $182.43 | $331.42 | $397.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $375.00
| Professional | | $375.00 | $375.00 | $375.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.59 / $259.77 / $429.30
| Professional | | $197.59 | $259.77 | $429.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.98 / $2,366.55 / $2,366.55
| Facility | | $716.98 | $2,366.55 | $2,366.55 |