- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.49 / $1,166.41 / $2,362.23
| Facility | | $630.49 | $1,166.41 | $2,362.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.49 / $664.11 / $748.18
| Professional | | $630.49 | $664.11 | $748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.14 / $630.49 / $1,345.04
| Professional | | $437.14 | $630.49 | $1,345.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.35 / $1,668.60 / $2,404.25
| Facility | | $557.35 | $1,668.60 | $2,404.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $1,024.65 / $1,280.81
| Professional | | $966.01 | $1,024.65 | $1,280.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.73 / $3,993.09 / $3,993.09
| Facility | | $1,462.73 | $3,993.09 | $3,993.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.63 / $504.39 / $840.65
| Facility | | $302.63 | $504.39 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $840.65
| Professional | | $353.07 | $504.39 | $840.65 |