- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.11 / $413.82 / $701.33
| Professional | | $290.11 | $413.82 | $701.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.87 / $58.58 / $58.58
| Facility | | $52.87 | $58.58 | $58.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.72 / $525.83 / $946.90
| Professional | | $345.72 | $525.83 | $946.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.14 / $112.14 / $112.14
| Facility | | $112.14 | $112.14 | $112.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.54 / $648.54 / $648.54
| Facility | | $648.54 | $648.54 | $648.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.87 / $659.87 / $1,335.94
| Professional | | $659.87 | $659.87 | $1,335.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $663.00 / $801.00
| Professional | | $638.07 | $663.00 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.74 / $4,248.00 / $4,402.87
| Facility | | $526.74 | $4,248.00 | $4,402.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.69 / $473.40 / $1,076.90
| Facility | | $94.69 | $473.40 | $1,076.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $659.87 / $659.87
| Professional | | $65.00 | $659.87 | $659.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.86 / $398.43 / $579.98
| Professional | | $297.86 | $398.43 | $579.98 |