- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.82 / $1,782.82 / $1,782.82
| Facility | | $1,782.82 | $1,782.82 | $1,782.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.57 / $679.09 / $880.45
| Professional | | $414.57 | $679.09 | $880.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.55 / $546.83 / $717.55
| Professional | | $422.55 | $546.83 | $717.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $633.82 / $820.24 / $1,076.32
| Professional | 50 | $633.82 | $820.24 | $1,076.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.81 / $1,005.81 / $1,005.81
| Facility | | $1,005.81 | $1,005.81 | $1,005.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.61 / $849.15 / $1,083.71
| Professional | | $656.61 | $849.15 | $1,083.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.09 / $661.58 / $1,029.42
| Professional | | $530.09 | $661.58 | $1,029.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.82 / $1,782.82 / $1,782.82
| Facility | | $1,782.82 | $1,782.82 | $1,782.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.13 / $524.67 / $795.35
| Professional | | $406.13 | $524.67 | $795.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.62 / $671.39 / $906.96
| Professional | | $419.62 | $671.39 | $906.96 |