- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.07 / $333.04 / $546.79
| Professional | | $309.07 | $333.04 | $546.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.46 / $624.46 / $749.35
| Professional | | $624.46 | $624.46 | $749.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.59 / $789.66 / $1,427.68
| Facility | | $218.59 | $789.66 | $1,427.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.47 / $728.63 / $910.79
| Professional | | $546.47 | $728.63 | $910.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.66 / $523.66 / $523.66
| Facility | | $523.66 | $523.66 | $523.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.28 / $382.28 / $865.88
| Professional | | $382.28 | $382.28 | $865.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.12 / $556.33 / $3,359.73
| Facility | | $201.12 | $556.33 | $3,359.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.29 / $311.54 / $469.28
| Professional | | $281.29 | $311.54 | $469.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.57 / $311.54 / $469.28
| Professional | | $281.57 | $311.54 | $469.28 |