- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $831.76
| Facility | | $575.44 | $676.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $870.96
| Professional | | $380.19 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $870.96
| Professional | | $691.83 | $812.83 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $1,047.13
| Professional | | $758.58 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $1,047.13
| Professional | | $346.74 | $691.83 | $1,047.13 |