- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $645.65
| Professional | | $288.40 | $426.58 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $602.56
| Facility | | $489.78 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $602.56
| Professional | | $363.08 | $524.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $1,096.48
| Facility | | $436.52 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $1,096.48
| Professional | | $436.52 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $812.83
| Facility | | $309.03 | $537.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $489.78 / $630.96
| Professional | | $79.43 | $489.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $426.58 / $457.09
| Facility | | $380.19 | $426.58 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $436.52
| Professional | | $257.04 | $288.40 | $436.52 |