- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $5,623.41
| Facility | | $831.76 | $1,096.48 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,122.02
| Professional | | $524.81 | $616.60 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,317.64 / $10,471.29
| Facility | | $2,187.76 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $676.08 / $1,071.52
| Professional | | $524.81 | $676.08 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $660.69
| Facility | | $524.81 | $588.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,318.26
| Facility | | $1,122.02 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,148.15
| Professional | | $562.34 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $5,754.40
| Facility | | $977.24 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $1,096.48
| Professional | | $489.78 | $630.96 | $1,096.48 |