- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.14 / $1,263.24 / $2,264.30
| Facility | | $556.14 | $1,263.24 | $2,264.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.08 / $522.38 / $675.32
| Professional | | $421.08 | $522.38 | $675.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $610.16
| Professional | | $239.16 | $239.16 | $610.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.39 / $1,678.37 / $2,859.95
| Facility | | $953.39 | $1,678.37 | $2,859.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.49 / $3,829.44 / $3,829.44
| Professional | | $967.49 | $3,829.44 | $3,829.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $953.39 / $1,787.60
| Facility | | $294.00 | $953.39 | $1,787.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.21 / $1,040.78 / $1,724.04
| Professional | | $834.21 | $1,040.78 | $1,724.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.32 / $794.49 / $1,440.64
| Professional | | $675.32 | $794.49 | $1,440.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,678.37 / $2,859.95
| Facility | | $555.00 | $1,678.37 | $2,859.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.41 / $858.05 / $1,827.33
| Professional | | $516.41 | $858.05 | $1,827.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.69 / $476.69 / $1,204.10
| Professional | | $333.69 | $476.69 | $1,204.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.67 / $913.64 / $913.64
| Facility | | $839.67 | $913.64 | $913.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.32 / $839.67 / $958.01
| Professional | | $675.32 | $839.67 | $958.01 |