- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.01 / $632.41 / $811.64
| Facility | | $558.01 | $632.41 | $811.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.64 / $811.64 / $811.64
| Professional | | $811.64 | $811.64 | $811.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.41 / $764.30 / $845.46
| Professional | | $637.41 | $764.30 | $845.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.01 / $811.64 / $946.92
| Professional | | $744.01 | $811.64 | $946.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.37 / $811.64 / $1,014.56
| Professional | | $676.37 | $811.64 | $1,014.56 |