- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,412.54
| Professional | | $724.44 | $954.99 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,137.96
| Facility | | $1,047.13 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,621.81 / $1,621.81
| Professional | | $1,548.82 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,023.29
| Facility | | $912.01 | $912.01 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $912.01
| Professional | | $660.69 | $660.69 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,230.27 / $1,862.09
| Facility | | $467.74 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $1,479.11
| Professional | | $1,230.27 | $1,412.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $1,047.13 / $1,288.25
| Professional | | $30.20 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,412.54 / $1,412.54
| Facility | | $1,380.38 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,148.15 / $1,621.81
| Professional | | $1,047.13 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $1,621.81
| Professional | | $1,148.15 | $1,479.11 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $954.99 / $1,096.48
| Facility | | $630.96 | $954.99 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $724.44 / $1,122.02
| Professional | | $676.08 | $724.44 | $1,122.02 |