- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,698.24 / $2,398.83
| Facility | | $537.03 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $724.44
| Professional | | $501.19 | $602.56 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $3,630.78
| Facility | | $831.76 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,884.03
| Professional | | $457.09 | $758.58 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,380.38
| Facility | | $758.58 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,230.27
| Facility | | $501.19 | $588.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,122.02
| Professional | | $933.25 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,288.25
| Professional | | $1,096.48 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,621.81
| Professional | | $758.58 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $3,630.78
| Facility | | $831.76 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,884.03
| Professional | | $457.09 | $758.58 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $912.01
| Facility | | $457.09 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $1,584.89
| Professional | | $457.09 | $758.58 | $1,584.89 |