- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.27 / $868.46 / $1,484.54
| Facility | | $742.27 | $868.46 | $1,484.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.92 / $868.46 / $868.46
| Professional | | $630.92 | $868.46 | $868.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.16 / $337.85 / $481.62
| Professional | | $278.16 | $337.85 | $481.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.79 / $627.22 / $2,327.98
| Facility | | $583.79 | $627.22 | $2,327.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $311.75 / $445.36
| Professional | | $311.75 | $311.75 | $445.36 |