- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.34 / $531.34 / $1,366.29
| Facility | | $531.34 | $531.34 | $1,366.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $713.51 / $713.51
| Professional | | $531.34 | $713.51 | $713.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.57 / $1,529.49 / $1,707.86
| Professional | | $1,142.57 | $1,529.49 | $1,707.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.26 / $872.26 / $1,280.51
| Professional | | $872.26 | $872.26 | $1,280.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.43 / $576.88 / $1,366.29
| Facility | | $455.43 | $576.88 | $1,366.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.12 / $910.86 / $1,518.10
| Professional | | $387.12 | $910.86 | $1,518.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $774.23 / $1,290.39
| Professional | | $318.80 | $774.23 | $1,290.39 |