- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.35 / $766.35 / $766.35
| Professional | | $621.35 | $766.35 | $766.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.53 / $646.40 / $976.38
| Professional | | $530.53 | $646.40 | $976.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.04 / $766.35 / $1,070.04
| Professional | | $645.04 | $766.35 | $1,070.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.34 / $617.05 / $960.15
| Professional | | $554.34 | $617.05 | $960.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.35 / $766.35 / $766.35
| Professional | | $621.35 | $766.35 | $766.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.92 / $758.39 / $960.15
| Professional | | $607.92 | $758.39 | $960.15 |