- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.86 / $869.70 / $3,170.07
| Facility | | $638.86 | $869.70 | $3,170.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.62 / $717.21 / $783.51
| Professional | | $361.62 | $717.21 | $783.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.60 / $1,177.01 / $1,854.63
| Facility | | $652.60 | $1,177.01 | $1,854.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.70 / $602.70 / $602.70
| Facility | | $602.70 | $602.70 | $602.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.76 / $485.39 / $4,577.04
| Facility | | $391.76 | $485.39 | $4,577.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $361.62 / $753.38
| Professional | | $253.13 | $361.62 | $753.38 |