- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,202.26
| Professional | | $549.54 | $724.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $1,995.26
| Facility | | $977.24 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,548.82 / $1,548.82
| Professional | | $1,479.11 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $870.96
| Facility | | $741.31 | $741.31 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $741.31
| Professional | | $537.03 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,071.52 / $1,412.54
| Facility | | $338.84 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $1,412.54
| Professional | | $1,071.52 | $1,318.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $1,023.29 / $1,202.26
| Professional | | $30.20 | $1,023.29 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,348.96 / $1,348.96
| Facility | | $1,318.26 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,548.82
| Professional | | $977.24 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $1,412.54
| Professional | | $1,096.48 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $933.25
| Facility | | $512.86 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $724.44
| Professional | | $478.63 | $524.81 | $724.44 |