- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.83 / $1,083.83 / $1,083.83
| Facility | | $1,083.83 | $1,083.83 | $1,083.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.23 / $754.57 / $1,207.31
| Professional | | $464.23 | $754.57 | $1,207.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.84 / $1,207.21 / $1,284.14
| Facility | | $1,146.84 | $1,207.21 | $1,284.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.57 / $1,267.57 / $1,267.57
| Professional | | $1,267.57 | $1,267.57 | $1,267.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.11 / $1,200.11 / $1,200.11
| Facility | | $1,200.11 | $1,200.11 | $1,200.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.09 / $1,200.11 / $2,487.66
| Professional | | $876.09 | $1,200.11 | $2,487.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.23 / $1,161.65 / $7,578.14
| Facility | | $464.23 | $1,161.65 | $7,578.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.40 / $825.30 / $1,841.46
| Professional | | $479.40 | $825.30 | $1,841.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.40 / $719.09 / $1,108.09
| Professional | | $479.40 | $719.09 | $1,108.09 |