- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,819.70 / $2,754.23
| Facility | | $891.25 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,995.26
| Facility | | $602.56 | $831.76 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $338.84
| Professional | | $251.19 | $295.12 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $181.97 / $295.12
| Facility | | $43.65 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $239.88 / $446.68
| Professional | | $194.98 | $239.88 | $446.68 |