- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,311.31 / $3,388.44
| Facility | | $724.44 | $3,311.31 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $891.25
| Professional | | $489.78 | $588.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $2,187.76
| Facility | | $1,230.27 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,621.81 / $1,995.26
| Professional | | $758.58 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $758.58 / $1,023.29
| Facility | | $724.44 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $831.76 / $1,047.13
| Professional | | $724.44 | $831.76 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,174.90
| Facility | | $676.08 | $831.76 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,047.13 / $1,995.26
| Facility | | $562.34 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $831.76 / $1,047.13
| Professional | | $79.43 | $831.76 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,187.76 / $2,951.21
| Facility | | $1,122.02 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $891.25
| Professional | | $602.56 | $630.96 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,202.26
| Facility | | $891.25 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $891.25
| Professional | | $316.23 | $316.23 | $891.25 |