- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $532.58
| Facility | | $529.89 | $529.89 | $532.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $556.38
| Professional | | $529.89 | $529.89 | $556.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,863.89 / $8,329.65 / $11,206.05
| Facility | | $6,863.89 | $8,329.65 | $11,206.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Facility | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.89 / $529.89 / $529.89
| Professional | | $525.89 | $529.89 | $529.89 |