- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,675.32 / $1,675.32 / $1,675.32
| Facility | | $1,675.32 | $1,675.32 | $1,675.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.95 / $215.61 / $238.92
| Professional | | $203.95 | $215.61 | $238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.36 / $343.16 / $372.94
| Facility | | $291.36 | $343.16 | $372.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.52 / $218.52 / $356.01
| Professional | | $218.52 | $218.52 | $356.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.31 / $773.31 / $773.31
| Facility | | $773.31 | $773.31 | $773.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.60 / $386.48 / $787.40
| Professional | | $144.60 | $386.48 | $787.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.37 / $174.82 / $420.23
| Professional | | $122.37 | $174.82 | $420.23 |