- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,621.81
| Facility | | $478.63 | $676.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $776.25
| Professional | | $281.84 | $457.09 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,288.25
| Facility | | $524.81 | $645.65 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $741.31
| Professional | | $281.84 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $371.54
| Facility | | $123.03 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $8,317.64 / $8,317.64
| Professional | | $1,122.02 | $8,317.64 | $8,317.64 |