- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.25 / $458.25 / $517.40
| Professional | | $458.25 | $458.25 | $517.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.44 / $477.57 / $722.48
| Professional | | $426.44 | $477.57 | $722.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.07 / $545.54 / $759.62
| Professional | | $445.07 | $545.54 | $759.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.89 / $506.00 / $776.23
| Professional | | $392.89 | $506.00 | $776.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.25 / $458.25 / $517.40
| Professional | | $458.25 | $458.25 | $517.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.77 / $514.53 / $697.97
| Professional | | $407.77 | $514.53 | $697.97 |