- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $794.33 / $1,122.02
| Facility | | $251.19 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $281.84 / $338.84
| Professional | | $234.42 | $281.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $1,778.28
| Professional | | $213.80 | $213.80 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $575.44
| Facility | | $234.42 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $524.81
| Professional | | $436.52 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $758.58
| Professional | | $354.81 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $1,778.28
| Professional | | $213.80 | $213.80 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $426.58
| Facility | | $213.80 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $741.31
| Professional | | $213.80 | $354.81 | $741.31 |