- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.49 / $1,281.49 / $1,692.17
| Facility | | $1,281.49 | $1,281.49 | $1,692.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.39 / $540.39 / $609.86
| Professional | | $540.39 | $540.39 | $609.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.59 / $1,432.95 / $2,026.57
| Facility | | $586.59 | $1,432.95 | $2,026.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.12 / $887.12 / $1,108.91
| Professional | | $887.12 | $887.12 | $1,108.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.18 / $617.58 / $771.98
| Facility | | $463.18 | $617.58 | $771.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.79 / $771.98 / $771.98
| Professional | | $501.79 | $771.98 | $771.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.23 / $385.99 / $771.98
| Professional | | $324.23 | $385.99 | $771.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.25 / $3,666.91 / $3,666.91
| Facility | | $1,343.25 | $3,666.91 | $3,666.91 |