- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.36 / $381.36 / $653.15
| Professional | | $381.36 | $381.36 | $653.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.73 / $431.73 / $431.73
| Facility | | $431.73 | $431.73 | $431.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.77 / $423.80 / $706.34
| Facility | | $359.77 | $423.80 | $706.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.36 / $381.36 / $381.36
| Professional | | $381.36 | $381.36 | $381.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.77 / $423.80 / $706.34
| Facility | | $359.77 | $423.80 | $706.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.36 / $381.36 / $381.36
| Professional | | $381.36 | $381.36 | $381.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.29 / $381.36 / $586.65
| Professional | | $362.29 | $381.36 | $586.65 |