- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.55 / $889.02 / $1,800.45
| Facility | | $480.55 | $889.02 | $1,800.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.55 / $506.18 / $570.25
| Professional | | $480.55 | $506.18 | $570.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.18 / $416.47 / $1,025.17
| Professional | | $333.18 | $416.47 | $1,025.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.06 / $1,380.64 / $1,832.47
| Facility | | $429.06 | $1,380.64 | $1,832.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.63 / $709.13 / $886.41
| Professional | | $668.63 | $709.13 | $886.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.86 / $3,043.47 / $3,043.47
| Facility | | $1,114.86 | $3,043.47 | $3,043.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.11 / $384.44 / $640.73
| Professional | | $269.11 | $384.44 | $640.73 |