- 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 / $779.38 / $1,024.33
| Professional | | $742.27 | $779.38 | $1,024.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.01 / $1,828.60 / $4,232.31
| Facility | | $1,349.01 | $1,828.60 | $4,232.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.54 / $742.27 / $794.23
| Facility | | $571.54 | $742.27 | $794.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $423.38 / $742.27
| Professional | | $311.75 | $423.38 | $742.27 |