- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,511.89 / $6,606.93
| Facility | | $977.24 | $2,511.89 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,230.27
| Professional | | $776.25 | $954.99 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,290.87 / $3,388.44
| Facility | | $707.95 | $2,290.87 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,096.48 / $2,137.96
| Professional | | $1,071.52 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $2,691.53
| Facility | | $758.58 | $977.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,398.83
| Facility | | $851.14 | $1,258.93 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $6,309.57
| Professional | | $537.03 | $537.03 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,258.93 / $1,513.56
| Facility | | $1,148.15 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $758.58
| Professional | | $537.03 | $537.03 | $758.58 |