- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.18 / $418.18 / $429.48
| Facility | | $418.18 | $418.18 | $429.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.18 / $429.48 / $441.16
| Professional | | $418.18 | $429.48 | $441.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.57 / $1,709.28 / $1,832.29
| Facility | | $1,370.57 | $1,709.28 | $1,832.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.76 / $88.76 / $88.76
| Professional | | $88.76 | $88.76 | $88.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.33 / $418.18 / $706.72
| Facility | | $410.33 | $418.18 | $706.72 |