- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.55 / $2,900.76 / $3,515.80
| Facility | | $714.55 | $2,900.76 | $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
- $562.80 / $1,092.83 / $2,789.31
| Facility | | $562.80 | $1,092.83 | $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
- $936.06 / $2,383.25 / $3,515.80
| Facility | | $936.06 | $2,383.25 | $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
- $562.80 / $1,092.83 / $2,789.31
| Facility | | $562.80 | $1,092.83 | $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 / $840.65
| Facility | | $840.65 | $840.65 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.77 / $840.65 / $840.65
| Professional | | $739.77 | $840.65 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $1,538.39
| Professional | | $353.07 | $504.39 | $1,538.39 |