- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.09 / $618.89 / $1,564.74
| Facility | | $373.09 | $618.89 | $1,564.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.09 / $381.87 / $782.37
| Professional | | $373.09 | $381.87 | $782.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,369.15 / $6,019.03
| Facility | | $1,303.95 | $1,369.15 | $6,019.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.76 / $684.16 / $1,246.54
| Professional | | $216.76 | $684.16 | $1,246.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.77 / $2,204.53 / $2,764.77
| Facility | | $418.77 | $2,204.53 | $2,764.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.53 / $445.41 / $1,498.36
| Professional | | $209.53 | $445.41 | $1,498.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.52 / $1,043.16 / $6,102.49
| Facility | | $276.52 | $1,043.16 | $6,102.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.35 / $361.26 / $1,564.74
| Professional | | $184.35 | $361.26 | $1,564.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.35 / $361.26 / $680.37
| Professional | | $184.35 | $361.26 | $680.37 |