- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.54 / $558.54 / $846.27
| Facility | | $558.54 | $558.54 | $846.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.54 / $558.54 / $5,441.52
| Professional | | $558.54 | $558.54 | $5,441.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.18 / $1,162.94 / $2,249.50
| Facility | | $884.18 | $1,162.94 | $2,249.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.01 / $1,345.56 / $1,387.88
| Professional | | $1,222.01 | $1,345.56 | $1,387.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,551.72 / $2,166.44
| Professional | | $1,015.52 | $1,551.72 | $2,166.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.66 / $1,061.23 / $4,019.78
| Facility | | $304.66 | $1,061.23 | $4,019.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $507.76 / $2,445.71
| Professional | | $507.76 | $507.76 | $2,445.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,633.39 / $3,329.29
| Facility | | $1,015.52 | $1,633.39 | $3,329.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.52 / $1,551.72 / $2,166.44
| Professional | | $1,015.52 | $1,551.72 | $2,166.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.14 / $1,438.66 / $1,726.39
| Professional | | $990.14 | $1,438.66 | $1,726.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $761.64
| Professional | | $355.43 | $507.76 | $761.64 |