- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.49 / $849.32 / $1,127.72
| Facility | | $478.49 | $849.32 | $1,127.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.40 / $398.74 / $398.74
| Professional | | $383.40 | $398.74 | $398.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.14 / $511.20 / $1,226.88
| Facility | | $166.14 | $511.20 | $1,226.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.13 / $210.16 / $375.22
| Professional | | $168.13 | $210.16 | $375.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.28 / $598.10 / $1,850.80
| Facility | | $332.28 | $598.10 | $1,850.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.29 / $587.29 / $734.11
| Professional | | $587.29 | $587.29 | $734.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.20 / $511.20 / $536.76
| Professional | | $511.20 | $511.20 | $536.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.80 / $766.80 / $766.80
| Facility | | $766.80 | $766.80 | $766.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.70 / $214.70 / $511.20
| Professional | | $214.70 | $214.70 | $511.20 |