- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.52 / $320.39 / $320.39
| Professional | | $298.52 | $320.39 | $320.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.43 / $206.56 / $650.00
| Professional | | $196.43 | $206.56 | $650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.20 / $247.20 / $247.20
| Facility | | $247.20 | $247.20 | $247.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.76 / $205.76 / $205.76
| Professional | | $205.76 | $205.76 | $205.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.46 / $200.46 / $200.46
| Professional | | $200.46 | $200.46 | $200.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.52 / $320.39 / $320.39
| Professional | | $298.52 | $320.39 | $320.39 |