- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.69 / $722.69 / $730.39
| Facility | | $722.69 | $722.69 | $730.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.29 / $722.69 / $768.50
| Professional | | $636.29 | $722.69 | $768.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.29 / $1,370.29 / $1,455.25
| Facility | | $1,370.29 | $1,370.29 | $1,455.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.12 / $822.12 / $1,060.11
| Professional | | $822.12 | $822.12 | $1,060.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.00 / $735.00 / $936.72
| Professional | | $735.00 | $735.00 | $936.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.50 / $870.50 / $870.50
| Facility | | $870.50 | $870.50 | $870.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.47 / $635.47 / $870.50
| Professional | | $635.47 | $635.47 | $870.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.20 / $1,233.26 / $1,644.35
| Professional | | $959.20 | $1,233.26 | $1,644.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.41 / $842.74 / $1,559.83
| Facility | | $433.41 | $842.74 | $1,559.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.00 / $1,799.88 / $2,282.46
| Professional | | $757.00 | $1,799.88 | $2,282.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.74 / $1,034.14 / $1,750.61
| Facility | | $750.74 | $1,034.14 | $1,750.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.74 / $1,034.14 / $1,750.61
| Professional | | $750.74 | $1,034.14 | $1,750.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.86 / $683.62 / $1,034.53
| Professional | | $617.86 | $683.62 | $1,034.53 |