- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $1,621.81
| Facility | | $426.58 | $794.33 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $478.63
| Professional | | $251.19 | $426.58 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $5,011.87
| Facility | | $1,949.84 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $602.56
| Facility | | $302.00 | $426.58 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $524.81 / $851.14
| Facility | | $154.88 | $524.81 | $851.14 |