- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.46 / $405.60 / $1,151.23
| Facility | | $217.46 | $405.60 | $1,151.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.52 / $217.46 / $217.46
| Professional | | $94.52 | $217.46 | $217.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $160.59 / $419.76
| Facility | | $105.78 | $160.59 | $419.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.89 / $769.28 / $791.43
| Facility | | $716.89 | $769.28 | $791.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.21 / $428.40 / $1,151.23
| Facility | | $239.21 | $428.40 | $1,151.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.51 / $217.46 / $645.85
| Professional | | $94.51 | $217.46 | $645.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $210.43 / $431.80
| Facility | | $105.78 | $210.43 | $431.80 |