- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.76 / $520.98 / $625.16
| Facility | | $341.76 | $520.98 | $625.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.58 / $341.76 / $354.26
| Professional | | $312.58 | $341.76 | $354.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.65 / $2,344.39 / $11,253.06
| Facility | | $562.65 | $2,344.39 | $11,253.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.14 / $562.65 / $119,998.80
| Professional | | $500.14 | $562.65 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.64 / $500.14 / $1,250.25
| Facility | | $338.64 | $500.14 | $1,250.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.88 / $2,008.88 / $2,008.88
| Professional | | $2,008.88 | $2,008.88 | $2,008.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $208.39 / $562.65
| Professional | | $175.05 | $208.39 | $562.65 |