- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $2,754.23
| Facility | | $371.54 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $575.44
| Professional | | $346.74 | $467.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,698.24 / $2,818.38
| Facility | | $724.44 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $588.84
| Professional | | $245.47 | $245.47 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $1,548.82
| Facility | | $309.03 | $380.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $851.14
| Professional | | $263.03 | $354.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $831.76 / $954.99
| Professional | | $812.83 | $831.76 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $588.84
| Professional | | $407.38 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $346.74
| Professional | | $245.47 | $245.47 | $346.74 |