- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.98 / $1,282.56 / $1,702.97
| Facility | | $836.98 | $1,282.56 | $1,702.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.99 / $578.99 / $578.99
| Professional | | $578.99 | $578.99 | $578.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.89 / $771.98 / $1,852.75
| Facility | | $250.89 | $771.98 | $1,852.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.79 / $467.04 / $566.63
| Professional | | $308.79 | $467.04 | $566.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.79 / $903.22 / $2,794.97
| Facility | | $501.79 | $903.22 | $2,794.97 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $193.00 / $771.98 / $810.58
| Professional | | $193.00 | $771.98 | $810.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.23 / $324.23 / $771.98
| Professional | | $324.23 | $324.23 | $771.98 |