- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.71 / $509.71 / $509.71
| Facility | | $509.71 | $509.71 | $509.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.52 / $481.52 / $509.71
| Professional | | $481.52 | $481.52 | $509.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.04 / $774.50 / $793.77
| Professional | | $655.04 | $774.50 | $793.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.25 / $811.28 / $1,020.13
| Professional | | $803.25 | $811.28 | $1,020.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.33 / $509.71 / $3,239.07
| Facility | | $323.33 | $509.71 | $3,239.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.10 / $342.88 / $558.20
| Professional | | $279.10 | $342.88 | $558.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.83 / $360.33 / $734.75
| Professional | | $241.83 | $360.33 | $734.75 |