- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.24 / $846.27 / $2,031.05
| Facility | | $626.24 | $846.27 | $2,031.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.24 / $1,103.35 / $1,500.00
| Professional | | $626.24 | $1,103.35 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.11 / $291.76 / $428.45
| Facility | | $218.11 | $291.76 | $428.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.96 / $803.96 / $803.96
| Professional | | $803.96 | $803.96 | $803.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.03 / $550.08 / $2,260.83
| Facility | | $410.03 | $550.08 | $2,260.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.98 / $1,030.53 / $1,234.70
| Professional | | $376.98 | $1,030.53 | $1,234.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.24 / $846.27 / $1,421.73
| Facility | | $626.24 | $846.27 | $1,421.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $1,269.41
| Professional | | $355.43 | $355.43 | $1,269.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $846.27
| Professional | | $355.43 | $355.43 | $846.27 |