- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $791.05 / $1,492.07
| Facility | | $416.78 | $791.05 | $1,492.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $416.78
| Professional | | $416.78 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.32 / $2,028.94 / $2,562.21
| Facility | | $1,582.32 | $2,028.94 | $2,562.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $599.16
| Professional | | $416.78 | $416.78 | $599.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.42 / $821.06 / $1,833.83
| Professional | | $333.42 | $821.06 | $1,833.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.91 / $696.24 / $2,135.39
| Facility | | $270.91 | $696.24 | $2,135.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $507.69 / $608.27
| Professional | | $416.78 | $507.69 | $608.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $500.14 / $616.83
| Professional | | $416.78 | $500.14 | $616.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $533.48 / $762.71
| Facility | | $416.78 | $533.48 | $762.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.96 / $729.37 / $1,000.27
| Professional | | $618.96 | $729.37 | $1,000.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.76 / $416.78 / $773.79
| Facility | | $341.76 | $416.78 | $773.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.76 / $416.78 / $787.71
| Professional | | $341.76 | $416.78 | $787.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.49 / $214.80 / $479.30
| Professional | | $173.49 | $214.80 | $479.30 |