- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.17 / $2,127.84 / $2,265.87
| Facility | | $307.17 | $2,127.84 | $2,265.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.76 / $409.30 / $619.20
| Professional | | $269.76 | $409.30 | $619.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.16 / $344.53 / $375.38
| Facility | | $314.16 | $344.53 | $375.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.11 / $333.67 / $333.67
| Professional | | $254.11 | $333.67 | $333.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.76 / $503.76 / $503.76
| Facility | | $503.76 | $503.76 | $503.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.26 / $495.28 / $1,249.75
| Professional | | $301.26 | $495.28 | $1,249.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,071.63 / $13,071.63 / $20,745.11
| Facility | | $13,071.63 | $13,071.63 | $20,745.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.26 / $474.57 / $682.52
| Professional | | $341.26 | $474.57 | $682.52 |