- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.25 / $958.38 / $1,086.60
| Facility | | $679.25 | $958.38 | $1,086.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.25 / $1,086.60 / $1,777.93
| Professional | | $679.25 | $1,086.60 | $1,777.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.94 / $940.94 / $2,352.35
| Professional | | $940.94 | $940.94 | $2,352.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.79 / $153.79 / $1,999.27
| Facility | | $153.79 | $153.79 | $1,999.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.79 / $153.79 / $1,999.27
| Professional | | $153.79 | $153.79 | $1,999.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.63 / $107.63 / $107.63
| Facility | | $107.63 | $107.63 | $107.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.49 / $91.49 / $141.27
| Professional | | $91.49 | $91.49 | $141.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.80 / $1,077.94 / $1,145.31
| Professional | | $1,056.80 | $1,077.94 | $1,145.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.63 / $107.63 / $555.00
| Facility | | $107.63 | $107.63 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.49 / $91.49 / $141.27
| Professional | | $91.49 | $91.49 | $141.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.39 / $122.78 / $896.21
| Professional | | $61.39 | $122.78 | $896.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.94 / $1,077.94 / $1,077.94
| Facility | | $1,077.94 | $1,077.94 | $1,077.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.94 / $1,077.94 / $1,145.31
| Professional | | $1,077.94 | $1,077.94 | $1,145.31 |