- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.55 / $1,097.56 / $1,967.33
| Facility | | $481.55 | $1,097.56 | $1,967.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.85 / $414.17 / $586.75
| Professional | | $365.85 | $414.17 | $586.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $938.92
| Professional | | $335.33 | $335.33 | $938.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.29 / $690.29 / $690.29
| Facility | | $690.29 | $690.29 | $690.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.91 / $690.29 / $690.29
| Professional | | $503.91 | $690.29 | $690.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.35 / $1,458.24 / $1,791.02
| Facility | | $828.35 | $1,458.24 | $1,791.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.98 / $3,327.20 / $3,327.20
| Professional | | $840.98 | $3,327.20 | $3,327.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $828.35 / $1,553.15
| Facility | | $294.00 | $828.35 | $1,553.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.80 / $911.18 / $1,497.93
| Professional | | $724.80 | $911.18 | $1,497.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.75 / $690.29 / $1,251.70
| Professional | | $586.75 | $690.29 | $1,251.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.65 / $1,683.98 / $1,791.02
| Facility | | $632.65 | $1,683.98 | $1,791.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.69 / $752.42 / $1,587.67
| Professional | | $448.69 | $752.42 | $1,587.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.92 / $414.17 / $1,046.19
| Professional | | $289.92 | $414.17 | $1,046.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.29 / $793.82 / $793.82
| Facility | | $690.29 | $793.82 | $793.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.75 / $690.29 / $829.67
| Professional | | $586.75 | $690.29 | $829.67 |