- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.09 / $880.26 / $880.26
| Professional | | $657.09 | $880.26 | $880.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.45 / $344.45 / $344.45
| Facility | | $344.45 | $344.45 | $344.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $344.45 / $344.45
| Professional | | $100.06 | $344.45 | $344.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.57 / $212.38 / $1,316.64
| Professional | | $82.57 | $212.38 | $1,316.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.45 / $657.09 / $1,091.02
| Facility | | $344.45 | $657.09 | $1,091.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $344.45 / $344.45
| Professional | | $100.06 | $344.45 | $344.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.94 / $595.91 / $736.48
| Professional | | $436.94 | $595.91 | $736.48 |