- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,479.11 / $1,905.46
| Facility | | $691.83 | $1,479.11 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,230.27
| Professional | | $645.65 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,380.38 / $2,238.72
| Facility | | $870.96 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,047.13 / $2,818.38
| Professional | | $630.96 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $1,737.80 / $3,311.31
| Facility | | $64.57 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,288.25 / $1,621.81
| Professional | | $478.63 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $4,897.79
| Professional | | $1,479.11 | $1,479.11 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $147.91 / $489.78
| Facility | | $46.77 | $147.91 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $2,290.87
| Professional | | $416.87 | $630.96 | $2,290.87 |