- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.53 / $1,306.45 / $2,818.23
| Facility | | $749.53 | $1,306.45 | $2,818.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.04 / $749.53 / $898.71
| Professional | | $691.04 | $749.53 | $898.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.41 / $944.16 / $1,426.84
| Professional | | $721.41 | $944.16 | $1,426.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.44 / $1,030.70 / $1,030.70
| Professional | | $318.44 | $1,030.70 | $1,030.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.59 / $1,236.07 / $2,885.85
| Facility | | $364.59 | $1,236.07 | $2,885.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.42 / $1,119.80 / $2,131.83
| Professional | | $791.42 | $1,119.80 | $2,131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.09 / $1,354.91 / $1,385.95
| Professional | | $970.09 | $1,354.91 | $1,385.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.53 / $1,166.58 / $1,482.87
| Facility | | $749.53 | $1,166.58 | $1,482.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.84 / $1,369.56 / $2,122.67
| Professional | | $998.84 | $1,369.56 | $2,122.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.17 / $1,149.56 / $3,082.09
| Facility | | $842.17 | $1,149.56 | $3,082.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.17 / $1,149.56 / $3,082.09
| Professional | | $842.17 | $1,149.56 | $3,082.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.23 / $1,035.39 / $2,474.34
| Facility | | $934.23 | $1,035.39 | $2,474.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.31 / $1,077.79 / $1,757.10
| Professional | | $710.31 | $1,077.79 | $1,757.10 |