- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.09 / $462.09 / $533.17
| Professional | | $462.09 | $462.09 | $533.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.74 / $528.74 / $528.74
| Facility | | $528.74 | $528.74 | $528.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.98 / $385.98 / $563.66
| Professional | | $385.98 | $385.98 | $563.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.74 / $528.74 / $528.74
| Facility | | $528.74 | $528.74 | $528.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.98 / $528.74 / $563.66
| Professional | | $385.98 | $528.74 | $563.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.52 / $711.61 / $1,094.68
| Professional | | $327.52 | $711.61 | $1,094.68 |