- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,995.26 / $3,715.35
| Facility | | $707.95 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $912.01
| Professional | | $630.96 | $724.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $3,801.89
| Facility | | $954.99 | $954.99 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $575.44
| Professional | | $338.84 | $338.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,862.09 / $4,265.80
| Facility | | $660.69 | $1,862.09 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,096.48 / $1,348.96
| Professional | | $398.11 | $1,096.48 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,148.15 / $1,412.54
| Professional | | $954.99 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $1,148.15
| Facility | | $630.96 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,995.26
| Professional | | $776.25 | $776.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $2,511.89
| Facility | | $660.69 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,071.52 / $2,511.89
| Professional | | $660.69 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $954.99 / $1,148.15
| Facility | | $398.11 | $954.99 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $426.58 / $707.95
| Professional | | $398.11 | $426.58 | $707.95 |