- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $1,635.40 / $2,287.56
| Facility | | $840.65 | $1,635.40 | $2,287.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.83 / $647.29 / $647.29
| Professional | | $554.83 | $647.29 | $647.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $1,526.90 / $1,908.62
| Professional | | $966.01 | $1,526.90 | $1,908.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.55 / $1,092.84 / $1,471.14
| Professional | | $714.55 | $1,092.84 | $1,471.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $1,092.84 / $3,283.81
| Facility | | $840.65 | $1,092.84 | $3,283.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.39 / $504.39 / $2,169.35
| Professional | | $504.39 | $504.39 | $2,169.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.62 / $1,471.14 / $2,312.16
| Facility | | $1,009.62 | $1,471.14 | $2,312.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.78 / $1,471.14 / $2,169.35
| Professional | | $1,008.78 | $1,471.14 | $2,169.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.39 / $504.39 / $1,933.50
| Professional | | $504.39 | $504.39 | $1,933.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.11 / $840.65 / $840.65
| Professional | | $664.11 | $840.65 | $840.65 |