- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.81 / $1,408.74 / $1,496.79
| Facility | | $679.81 | $1,408.74 | $1,496.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.04 / $1,461.57 / $1,496.79
| Professional | | $1,215.04 | $1,461.57 | $1,496.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.96 / $1,467.44 / $1,467.44
| Professional | | $478.96 | $1,467.44 | $1,467.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.89 / $703.11 / $703.11
| Facility | | $653.89 | $703.11 | $703.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.11 / $703.11 / $703.11
| Professional | | $703.11 | $703.11 | $703.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.77 / $482.77 / $482.77
| Facility | | $482.77 | $482.77 | $482.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.35 / $410.35 / $482.77
| Professional | | $410.35 | $410.35 | $482.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $843.92 / $1,898.82
| Facility | | $319.00 | $843.92 | $1,898.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.91 / $632.94 / $1,537.62
| Professional | | $497.91 | $632.94 | $1,537.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.34 / $583.66 / $703.11
| Professional | | $549.34 | $583.66 | $703.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.77 / $482.77 / $843.92
| Facility | | $482.77 | $482.77 | $843.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.35 / $482.77 / $1,308.08
| Professional | | $410.35 | $482.77 | $1,308.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.68 / $513.91 / $759.53
| Professional | | $280.68 | $513.91 | $759.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.34 / $549.34 / $549.34
| Facility | | $549.34 | $549.34 | $549.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.34 / $549.34 / $583.66
| Professional | | $549.34 | $549.34 | $583.66 |