- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.59 / $578.97 / $3,520.14
| Facility | | $519.59 | $578.97 | $3,520.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.97 / $578.97 / $645.77
| Professional | | $578.97 | $578.97 | $645.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $1,015.05
| Professional | | $742.27 | $742.27 | $1,015.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.61 / $1,505.34 / $4,232.31
| Facility | | $494.61 | $1,505.34 | $4,232.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.97 / $742.27 / $935.26
| Facility | | $578.97 | $742.27 | $935.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $408.25 / $675.92
| Professional | | $311.75 | $408.25 | $675.92 |