- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.51 / $263.51 / $263.51
| Facility | | $263.51 | $263.51 | $263.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.33 / $263.51 / $326.45
| Professional | | $253.33 | $263.51 | $326.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.98 / $4,300.63 / $8,883.07
| Facility | | $1,981.98 | $4,300.63 | $8,883.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,209.52 / $1,511.90 / $1,511.90
| Professional | | $1,209.52 | $1,511.90 | $1,511.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.30 / $492.81 / $540.16
| Facility | | $364.30 | $492.81 | $540.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.54 / $1,819.54 / $1,819.54
| Professional | | $1,819.54 | $1,819.54 | $1,819.54 |