- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.31 / $317.08 / $407.68
| Facility | | $308.31 | $317.08 | $407.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.24 / $331.01 / $421.62
| Professional | | $279.24 | $331.01 | $421.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.23 / $721.37 / $1,136.58
| Facility | | $581.23 | $721.37 | $1,136.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.26 / $350.31 / $488.60
| Professional | | $326.26 | $350.31 | $488.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.88 / $372.88 / $397.10
| Facility | | $372.88 | $372.88 | $397.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.20 / $372.88 / $397.51
| Professional | | $272.20 | $372.88 | $397.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $293.81 / $475.75
| Professional | | $247.07 | $293.81 | $475.75 |