- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $1,202.26
| Facility | | $363.08 | $512.86 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $407.38
| Professional | | $208.93 | $263.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $954.99
| Facility | | $389.05 | $489.78 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $323.59
| Professional | | $204.17 | $204.17 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $199.53 / $245.47
| Facility | | $190.55 | $199.53 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $776.25 / $776.25
| Professional | | $208.93 | $776.25 | $776.25 |