- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.38 / $228.38 / $285.47
| Professional | | $228.38 | $228.38 | $285.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $269.56 / $323.66
| Facility | | $1.00 | $269.56 | $323.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.75 / $277.32 / $475.92
| Professional | | $243.75 | $277.32 | $475.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.99 / $336.24 / $473.95
| Facility | | $268.99 | $336.24 | $473.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.75 / $276.57 / $475.92
| Professional | | $243.75 | $276.57 | $475.92 |