- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,318.26 / $1,819.70
| Facility | | $407.38 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $562.34
| Professional | | $389.05 | $467.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,548.82 / $2,754.23
| Facility | | $645.65 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $2,187.76
| Professional | | $354.81 | $588.84 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $933.25
| Facility | | $398.11 | $457.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $851.14
| Professional | | $707.95 | $707.95 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,318.26
| Professional | | $501.19 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,548.82 / $2,754.23
| Facility | | $645.65 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $2,187.76
| Professional | | $354.81 | $588.84 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $707.95
| Facility | | $354.81 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $1,288.25
| Professional | | $354.81 | $457.09 | $1,288.25 |