- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,238.72 / $5,011.87
| Facility | | $1,202.26 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $1,445.44
| Professional | | $316.23 | $467.74 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $707.95
| Professional | | $295.12 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,995.26
| Facility | | $1,479.11 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $676.08
| Professional | | $269.15 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $1,949.84
| Professional | | $288.40 | $398.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $2,238.72
| Professional | | $426.58 | $426.58 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $758.58
| Professional | | $288.40 | $288.40 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,995.26 / $6,456.54
| Facility | | $724.44 | $1,995.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $602.56
| Professional | | $288.40 | $389.05 | $602.56 |