- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.96 / $540.96 / $876.05
| Professional | | $540.96 | $540.96 | $876.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.06 / $329.95 / $650.00
| Professional | | $266.06 | $329.95 | $650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.40 / $920.40 / $920.40
| Professional | | $920.40 | $920.40 | $920.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.35 / $203.35 / $203.35
| Professional | | $203.35 | $203.35 | $203.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.96 / $540.96 / $876.05
| Professional | | $540.96 | $540.96 | $876.05 |