- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $477.80 / $639.91
| Professional | | $320.45 | $477.80 | $639.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.42 / $581.42 / $763.12
| Facility | | $581.42 | $581.42 | $763.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.22 / $581.42 / $763.12
| Professional | | $494.22 | $581.42 | $763.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.42 / $581.42 / $763.12
| Facility | | $581.42 | $581.42 | $763.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.42 / $581.42 / $763.12
| Professional | | $581.42 | $581.42 | $763.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.67 / $665.35 / $862.32
| Professional | | $299.67 | $665.35 | $862.32 |