- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $2,041.74
| Facility | | $758.58 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $446.68 / $1,122.02
| Professional | | $223.87 | $446.68 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $1,148.15
| Professional | | $275.42 | $338.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,513.56
| Facility | | $1,096.48 | $1,096.48 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $1,122.02
| Professional | | $245.47 | $323.59 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $588.84
| Facility | | $512.86 | $562.34 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $575.44 / $1,288.25
| Professional | | $239.88 | $575.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,288.25 / $3,388.44
| Facility | | $562.34 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $616.60 / $1,174.90
| Professional | | $229.09 | $616.60 | $1,174.90 |