- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.83 / $313.68 / $1,620.22
| Facility | | $235.83 | $313.68 | $1,620.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.68 / $313.68 / $348.18
| Professional | | $313.68 | $313.68 | $348.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.50 / $328.50 / $352.32
| Facility | | $328.50 | $328.50 | $352.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.86 / $486.76 / $486.76
| Facility | | $313.86 | $486.76 | $486.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.76 / $486.76 / $486.76
| Professional | | $486.76 | $486.76 | $486.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.89 / $378.73 / $529.09
| Professional | | $340.89 | $378.73 | $529.09 |