- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $2,951.21
| Professional | | $1,230.27 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $144.54 / $147.91
| Professional | | $123.03 | $144.54 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,122.02 / $1,995.26
| Facility | | $275.42 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,148.15 / $2,951.21
| Professional | | $60.26 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $2,754.23
| Facility | | $213.80 | $275.42 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $478.63 / $2,754.23
| Professional | | $229.09 | $478.63 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $2,344.23
| Facility | | $812.83 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $144.54 / $1,819.70
| Professional | | $60.26 | $144.54 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $562.34 / $1,318.26
| Facility | | $85.11 | $562.34 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,778.28 / $3,467.37
| Professional | | $933.25 | $1,778.28 | $3,467.37 |