- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,445.44 / $2,137.96
| Facility | | $316.23 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $524.81
| Professional | | $316.23 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $467.74
| Facility | | $234.42 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $707.95
| Professional | | $263.03 | $309.03 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $354.81
| Facility | | $257.04 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $616.60
| Facility | | $302.00 | $302.00 | $616.60 |