- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.55 / $2,400.21 / $3,515.80
| Facility | | $714.55 | $2,400.21 | $3,515.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.72 / $680.93 / $714.55
| Professional | | $551.72 | $680.93 | $714.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.71 / $655.71 / $655.71
| Professional | | $655.71 | $655.71 | $655.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.53 / $1,092.18 / $2,789.31
| Facility | | $552.53 | $1,092.18 | $2,789.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $966.01 / $1,207.51
| Professional | | $966.01 | $966.01 | $1,207.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.70 / $495.98 / $1,138.24
| Professional | | $386.70 | $495.98 | $1,138.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.87 / $2,301.54 / $3,515.80
| Facility | | $865.87 | $2,301.54 | $3,515.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.72 / $689.33 / $3,471.88
| Professional | | $551.72 | $689.33 | $3,471.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.41 / $1,119.45 / $2,789.31
| Facility | | $587.41 | $1,119.45 | $2,789.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $966.01 / $1,207.51
| Professional | | $966.01 | $966.01 | $1,207.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $840.65 / $924.72
| Facility | | $840.65 | $840.65 | $924.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.77 / $840.65 / $924.72
| Professional | | $739.77 | $840.65 | $924.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $1,303.01
| Professional | | $353.07 | $504.39 | $1,303.01 |