- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,047.13
| Professional | | $446.68 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,238.72 / $91,201.08
| Facility | | $851.14 | $2,238.72 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $933.25
| Professional | | $316.23 | $316.23 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,949.84
| Facility | | $645.65 | $794.33 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,949.84
| Professional | | $645.65 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $1,412.54
| Facility | | $575.44 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,023.29
| Professional | | $575.44 | $575.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $645.65
| Professional | | $269.15 | $269.15 | $645.65 |