- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $2,454.71
| Facility | | $1,548.82 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $602.56
| Professional | | $316.23 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $426.58
| Professional | | $223.87 | $309.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $645.65 / $831.76
| Facility | | $239.88 | $645.65 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |