- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.08 / $508.46 / $1,341.59
| Facility | | $490.08 | $508.46 | $1,341.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.08 / $508.46 / $520.71
| Professional | | $490.08 | $508.46 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $566.50
| Facility | | $520.71 | $520.71 | $566.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Facility | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $510.50 / $536.03
| Professional | | $510.50 | $510.50 | $536.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $510.50 / $510.50
| Professional | | $510.50 | $510.50 | $510.50 |