- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.47 / $343.47 / $601.50
| Professional | | $343.47 | $343.47 | $601.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.83 / $670.83 / $670.83
| Professional | | $670.83 | $670.83 | $670.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $234.00 / $755.62
| Facility | | $234.00 | $234.00 | $755.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.00 / $234.00 / $234.00
| Professional | | $234.00 | $234.00 | $234.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.89 / $291.29 / $438.81
| Professional | | $246.89 | $291.29 | $438.81 |