- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.82 / $518.21 / $800.74
| Facility | | $261.82 | $518.21 | $800.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.09 / $218.18 / $268.33
| Professional | | $188.09 | $218.18 | $268.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.41 / $263.41 / $263.41
| Professional | | $263.41 | $263.41 | $263.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.82 / $324.52 / $1,370.06
| Facility | | $164.82 | $324.52 | $1,370.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.27 / $360.34 / $485.00
| Professional | | $288.27 | $360.34 | $485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.65 / $182.65 / $436.36
| Facility | | $182.65 | $182.65 | $436.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $150.47 / $360.98
| Professional | | $105.33 | $150.47 | $360.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.65 / $689.65 / $689.65
| Facility | | $689.65 | $689.65 | $689.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $150.47 / $360.98
| Professional | | $105.33 | $150.47 | $360.98 |