- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.78 / $1,650.78 / $1,650.78
| Facility | | $1,650.78 | $1,650.78 | $1,650.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.55 / $457.55 / $554.84
| Professional | | $457.55 | $457.55 | $554.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.44 / $683.32 / $1,020.54
| Professional | | $545.44 | $683.32 | $1,020.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.76 / $747.55 / $1,036.53
| Professional | | $595.76 | $747.55 | $1,036.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.22 / $764.01 / $1,172.04
| Professional | | $593.22 | $764.01 | $1,172.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.78 / $1,650.78 / $1,650.78
| Facility | | $1,650.78 | $1,650.78 | $1,650.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.55 / $457.55 / $554.84
| Professional | | $457.55 | $457.55 | $554.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.65 / $716.33 / $1,070.60
| Professional | | $572.65 | $716.33 | $1,070.60 |