- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.24 / $575.28 / $750.00
| Professional | | $566.24 | $575.28 | $750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.00 / $1,387.20 / $2,508.00
| Facility | | $384.00 | $1,387.20 | $2,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.00 / $1,280.00 / $1,744.00
| Professional | | $960.00 | $1,280.00 | $1,744.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.24 / $575.28 / $750.00
| Facility | | $566.24 | $575.28 | $750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.00 / $750.00 / $1,074.18
| Professional | | $750.00 | $750.00 | $1,074.18 |