- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,023.29
| Professional | | $512.86 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,737.80
| Facility | | $831.76 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,318.26 / $1,318.26
| Professional | | $1,258.93 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $870.96
| Facility | | $776.25 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $776.25
| Professional | | $562.34 | $562.34 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $977.24 / $1,380.38
| Facility | | $338.84 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $1,202.26
| Professional | | $794.33 | $1,148.15 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $851.14 / $1,023.29
| Professional | | $30.20 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,148.15 / $1,148.15
| Facility | | $1,122.02 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,318.26
| Professional | | $831.76 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,202.26
| Professional | | $933.25 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $794.33
| Facility | | $512.86 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $724.44
| Professional | | $478.63 | $524.81 | $724.44 |