- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,187.76
| Facility | | $1,513.56 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $1,621.81
| Professional | | $323.59 | $676.08 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,479.11 / $3,019.95
| Facility | | $831.76 | $1,479.11 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $851.14
| Professional | | $724.44 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,737.80 / $3,311.31
| Facility | | $660.69 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $794.33 / $1,380.38
| Professional | | $630.96 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $851.14 / $1,258.93
| Facility | | $831.76 | $851.14 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $891.25 / $1,047.13
| Professional | | $831.76 | $891.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $724.44
| Professional | | $616.60 | $616.60 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,019.95
| Facility | | $1,258.93 | $1,584.89 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $891.25
| Professional | | $707.95 | $707.95 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $707.95
| Professional | | $245.47 | $354.81 | $707.95 |