- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $954.99
| Facility | | $588.84 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $190.55 / $354.81
| Professional | | $102.33 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $537.03 / $851.14
| Professional | | $288.40 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $218.78 / $436.52
| Professional | | $120.23 | $218.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $3,090.30
| Facility | | $208.93 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $478.63
| Professional | | $131.83 | $234.42 | $478.63 |