- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.14 / $2,663.78 / $3,188.28
| Facility | | $795.14 | $2,663.78 | $3,188.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.65 / $609.86 / $656.18
| Professional | | $506.65 | $609.86 | $656.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.14 / $602.14 / $602.14
| Professional | | $602.14 | $602.14 | $602.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.39 / $1,002.98 / $2,562.21
| Facility | | $507.39 | $1,002.98 | $2,562.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.12 / $887.12 / $1,108.91
| Professional | | $887.12 | $887.12 | $1,108.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.11 / $455.47 / $1,045.26
| Professional | | $355.11 | $455.47 | $1,045.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.14 / $2,894.92 / $3,188.28
| Facility | | $795.14 | $2,894.92 | $3,188.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.65 / $625.29 / $3,188.28
| Professional | | $506.65 | $625.29 | $3,188.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.44 / $1,028.02 / $2,562.21
| Facility | | $539.44 | $1,028.02 | $2,562.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.12 / $887.12 / $1,108.91
| Professional | | $887.12 | $887.12 | $1,108.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.98 / $771.98 / $849.18
| Facility | | $771.98 | $771.98 | $849.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.34 / $771.98 / $849.18
| Professional | | $679.34 | $771.98 | $849.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.23 / $463.19 / $1,343.25
| Professional | | $324.23 | $463.19 | $1,343.25 |