- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.28 / $634.28 / $875.92
| Facility | | $634.28 | $634.28 | $875.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.04 / $634.28 / $634.28
| Professional | | $302.04 | $634.28 | $634.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.20 / $379.56 / $903.10
| Facility | | $327.20 | $379.56 | $903.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.20 / $578.20 / $722.75
| Professional | | $578.20 | $578.20 | $722.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.06 / $453.06 / $503.40
| Facility | | $453.06 | $453.06 | $503.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $302.04 / $503.40
| Professional | | $211.43 | $302.04 | $503.40 |