- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.52 / $448.52 / $679.57
| Facility | | $448.52 | $448.52 | $679.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.52 / $448.52 / $4,369.64
| Professional | | $448.52 | $448.52 | $4,369.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.18 / $1,162.94 / $2,249.50
| Facility | | $884.18 | $1,162.94 | $2,249.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.65 / $1,052.31 / $1,114.49
| Professional | | $543.65 | $1,052.31 | $1,114.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.98 / $1,234.44 / $1,543.06
| Professional | | $780.98 | $1,234.44 | $1,543.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.74 / $1,020.53 / $3,227.96
| Facility | | $407.74 | $1,020.53 | $3,227.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $407.74 / $1,963.96
| Professional | | $407.74 | $407.74 | $1,963.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.17 / $1,293.72 / $2,667.56
| Facility | | $816.17 | $1,293.72 | $2,667.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.48 / $1,293.72 / $1,773.68
| Professional | | $815.48 | $1,293.72 | $1,773.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.10 / $1,155.27 / $1,386.32
| Professional | | $795.10 | $1,155.27 | $1,386.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.35 / $407.74 / $1,325.16
| Professional | | $387.35 | $407.74 | $1,325.16 |