- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.43 / $434.85 / $1,585.06
| Facility | | $319.43 | $434.85 | $1,585.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $358.61 / $391.76
| Professional | | $180.81 | $358.61 | $391.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.19 / $676.87 / $1,001.37
| Facility | | $349.19 | $676.87 | $1,001.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.27 / $286.27 / $331.49
| Professional | | $286.27 | $286.27 | $331.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $301.35
| Facility | | $301.35 | $301.35 | $301.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.41 / $578.35 / $2,127.69
| Facility | | $315.41 | $578.35 | $2,127.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $171.80 / $391.76
| Professional | | $126.57 | $171.80 | $391.76 |