- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,137.96 / $3,162.28
| Facility | | $602.56 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $741.31
| Professional | | $489.78 | $575.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,230.27 / $3,801.89
| Facility | | $1,122.02 | $1,230.27 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $870.96 / $2,884.03
| Professional | | $436.52 | $870.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,122.02
| Facility | | $691.83 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $933.25 / $1,288.25
| Facility | | $776.25 | $933.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,071.52 / $2,089.30
| Professional | | $588.84 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,148.15 / $8,511.38
| Facility | | $645.65 | $1,148.15 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $1,230.27
| Professional | | $398.11 | $724.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $1,819.70
| Professional | | $660.69 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,230.27 / $3,801.89
| Facility | | $1,122.02 | $1,230.27 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $870.96 / $2,884.03
| Professional | | $436.52 | $870.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $812.83 / $1,412.54
| Facility | | $501.19 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $912.01 / $1,819.70
| Professional | | $549.54 | $912.01 | $1,819.70 |