- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.08 / $549.77 / $1,017.66
| Facility | | $430.08 | $549.77 | $1,017.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.08 / $741.94 / $956.05
| Professional | | $430.08 | $741.94 | $956.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.33 / $1,288.59 / $2,526.66
| Facility | | $1,263.33 | $1,288.59 | $2,526.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.53 / $765.53 / $2,040.13
| Professional | | $765.53 | $765.53 | $2,040.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.86 / $1,052.54 / $1,052.54
| Facility | | $978.86 | $1,052.54 | $1,052.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.54 / $1,052.54 / $1,052.54
| Professional | | $1,052.54 | $1,052.54 | $1,052.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.54 / $906.54 / $906.54
| Facility | | $906.54 | $906.54 | $906.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.77 / $661.77 / $1,024.81
| Professional | | $661.77 | $661.77 | $1,024.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,263.33 / $2,842.49
| Facility | | $319.00 | $1,263.33 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.06 / $947.50 / $2,273.98
| Professional | | $682.06 | $947.50 | $2,273.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.57 / $852.57 / $852.57
| Facility | | $852.57 | $852.57 | $852.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.52 / $806.99 / $1,023.08
| Professional | | $759.52 | $806.99 | $1,023.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.73 / $1,024.73 / $1,024.73
| Professional | | $1,024.73 | $1,024.73 | $1,024.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $906.54 / $1,263.33
| Facility | | $597.00 | $906.54 | $1,263.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.77 / $881.09 / $1,882.36
| Professional | | $661.77 | $881.09 | $1,882.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.18 / $667.54 / $1,155.48
| Professional | | $420.18 | $667.54 | $1,155.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.30 / $759.52 / $759.52
| Facility | | $675.30 | $759.52 | $759.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.52 / $759.52 / $852.57
| Professional | | $759.52 | $759.52 | $852.57 |