- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.55 / $762.76 / $1,334.53
| Facility | | $163.55 | $762.76 | $1,334.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.55 / $163.55 / $395.79
| Professional | | $163.55 | $163.55 | $395.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.25 / $218.06 / $1,176.41
| Professional | | $196.25 | $218.06 | $1,176.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.35 / $368.52 / $792.78
| Facility | | $354.35 | $368.52 | $792.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.77 / $396.79 / $1,698.75
| Professional | | $158.77 | $396.79 | $1,698.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.77 / $443.25 / $443.25
| Professional | | $250.77 | $443.25 | $443.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.59 / $130.84 / $462.98
| Professional | | $91.59 | $130.84 | $462.98 |