- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.39 / $575.39 / $663.91
| Professional | | $575.39 | $575.39 | $663.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.83 / $740.83 / $866.61
| Facility | | $740.83 | $740.83 | $866.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.80 / $740.83 / $763.05
| Professional | | $540.80 | $740.83 | $763.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.83 / $740.83 / $866.61
| Facility | | $740.83 | $740.83 | $866.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.80 / $740.83 / $763.05
| Professional | | $540.80 | $740.83 | $763.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.16 / $698.45 / $1,363.10
| Professional | | $392.16 | $698.45 | $1,363.10 |