- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.42 / $480.16 / $1,155.09
| Facility | | $338.42 | $480.16 | $1,155.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.06 / $259.10 / $444.78
| Professional | | $206.06 | $259.10 | $444.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.61 / $423.35 / $909.53
| Facility | | $266.61 | $423.35 | $909.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.02 / $241.48 / $411.85
| Professional | | $204.02 | $241.48 | $411.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.72 / $477.72 / $477.72
| Facility | | $477.72 | $477.72 | $477.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.55 / $684.55 / $684.55
| Professional | | $684.55 | $684.55 | $684.55 |