- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.40 / $956.40 / $1,320.75
| Facility | | $956.40 | $956.40 | $1,320.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $736.28 / $956.40
| Professional | | $455.43 | $736.28 | $956.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.38 / $979.33 / $1,422.94
| Facility | | $493.38 | $979.33 | $1,422.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.15 / $948.81 / $948.81
| Facility | | $683.15 | $948.81 | $948.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $796.75
| Professional | | $318.80 | $455.43 | $796.75 |