- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.38 / $722.89 / $722.89
| Facility | | $598.38 | $722.89 | $722.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.38 / $722.89 / $784.28
| Professional | | $598.38 | $722.89 | $784.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.04 / $1,462.04 / $1,552.69
| Facility | | $1,462.04 | $1,462.04 | $1,552.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.97 / $829.97 / $1,102.57
| Professional | | $829.97 | $829.97 | $1,102.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.00 / $784.00 / $999.44
| Professional | | $784.00 | $784.00 | $999.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.38 / $888.38 / $888.38
| Facility | | $888.38 | $888.38 | $888.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.52 / $648.52 / $888.38
| Professional | | $648.52 | $648.52 | $888.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.43 / $1,315.84 / $1,754.45
| Professional | | $1,023.43 | $1,315.84 | $1,754.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.31 / $899.19 / $1,664.27
| Facility | | $442.31 | $899.19 | $1,664.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.00 / $1,827.55 / $2,435.28
| Professional | | $1,001.00 | $1,827.55 | $2,435.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.02 / $1,103.40 / $1,744.91
| Facility | | $801.02 | $1,103.40 | $1,744.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.02 / $1,103.40 / $1,744.91
| Professional | | $801.02 | $1,103.40 | $1,744.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.46 / $729.40 / $1,095.92
| Professional | | $633.46 | $729.40 | $1,095.92 |