- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $912.01
| Professional | | $478.63 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $891.25
| Facility | | $575.44 | $741.31 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $812.83
| Professional | | $602.56 | $602.56 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,122.02 / $1,548.82
| Professional | | $371.54 | $1,122.02 | $1,548.82 |