- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.59 / $1,180.21 / $2,115.46
| Facility | | $519.59 | $1,180.21 | $2,115.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.40 / $488.04 / $630.92
| Professional | | $393.40 | $488.04 | $630.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.20 / $699.20 / $1,692.38
| Professional | | $699.20 | $699.20 | $1,692.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.72 / $1,568.06 / $2,672.47
| Facility | | $890.72 | $1,568.06 | $2,672.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.45 / $3,577.74 / $3,577.74
| Professional | | $904.45 | $3,577.74 | $3,577.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $964.95 / $1,670.11
| Facility | | $319.00 | $964.95 | $1,670.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.59 / $964.95 / $1,610.73
| Professional | | $519.59 | $964.95 | $1,610.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.92 / $742.27 / $1,345.95
| Professional | | $630.92 | $742.27 | $1,345.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $1,568.06 / $2,672.47
| Facility | | $597.00 | $1,568.06 | $2,672.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.48 / $801.65 / $1,707.22
| Professional | | $482.48 | $801.65 | $1,707.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $425.92 / $1,124.97
| Professional | | $311.75 | $425.92 | $1,124.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.02 / $853.59 / $853.59
| Facility | | $758.02 | $853.59 | $853.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.92 / $758.02 / $892.15
| Professional | | $630.92 | $758.02 | $892.15 |