- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.94 / $1,369.94 / $1,973.53
| Facility | | $1,369.94 | $1,369.94 | $1,973.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $1,480.15 / $1,480.15
| Professional | | $531.34 | $1,480.15 | $1,480.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.07 / $804.21 / $2,960.28
| Facility | | $740.07 | $804.21 | $2,960.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.06 / $720.83 / $1,090.32
| Professional | | $340.06 | $720.83 | $1,090.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.51 / $1,480.15 / $1,628.17
| Facility | | $713.51 | $1,480.15 | $1,628.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $910.86
| Professional | | $759.05 | $759.05 | $910.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.15 / $1,480.15 / $1,480.15
| Professional | | $1,480.15 | $1,480.15 | $1,480.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.58 / $1,707.86 / $2,793.30
| Facility | | $1,138.58 | $1,707.86 | $2,793.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.19 / $1,334.94 / $1,334.94
| Professional | | $645.19 | $1,334.94 | $1,334.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $336.98 / $962.80
| Professional | | $318.80 | $336.98 | $962.80 |