- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.36 / $1,262.66 / $1,676.56
| Facility | | $711.36 | $1,262.66 | $1,676.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.60 / $592.79 / $1,482.00
| Professional | | $425.60 | $592.79 | $1,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.35 / $760.00 / $950.00
| Facility | | $338.35 | $760.00 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $304.00 / $459.80
| Professional | | $304.00 | $304.00 | $459.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $889.20 / $1,235.00
| Facility | | $494.00 | $889.20 | $1,235.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.60 / $925.90 / $1,109.33
| Professional | | $444.60 | $925.90 | $1,109.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.00 / $190.00 / $798.00
| Professional | | $190.00 | $190.00 | $798.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.00 / $190.00 / $190.00
| Professional | | $190.00 | $190.00 | $190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.00 / $1,140.00 / $1,140.00
| Facility | | $1,140.00 | $1,140.00 | $1,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $319.20 / $760.00
| Professional | | $319.20 | $319.20 | $760.00 |