- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.23 / $769.23 / $777.42
| Facility | | $769.23 | $769.23 | $777.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.38 / $769.23 / $801.78
| Professional | | $710.38 | $769.23 | $801.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.52 / $1,458.52 / $1,548.95
| Facility | | $1,458.52 | $1,458.52 | $1,548.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.81 / $811.81 / $1,038.66
| Professional | | $811.81 | $811.81 | $1,038.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.16 / $813.16 / $813.16
| Professional | | $813.16 | $813.16 | $813.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.10 / $967.10 / $967.10
| Facility | | $967.10 | $967.10 | $967.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.98 / $705.98 / $967.10
| Professional | | $705.98 | $705.98 | $967.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.96 / $1,312.67 / $1,750.22
| Professional | | $1,020.96 | $1,312.67 | $1,750.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.45 / $897.02 / $1,622.59
| Facility | | $451.45 | $897.02 | $1,622.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.11 / $1,915.79 / $2,429.44
| Professional | | $1,129.11 | $1,915.79 | $2,429.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.08 / $1,105.77 / $1,740.73
| Facility | | $822.08 | $1,105.77 | $1,740.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.08 / $1,105.77 / $1,740.73
| Professional | | $822.08 | $1,105.77 | $1,740.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.00 / $727.64 / $1,096.09
| Professional | | $666.00 | $727.64 | $1,096.09 |