- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.70 / $742.01 / $2,008.57
| Facility | | $458.70 | $742.01 | $2,008.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.69 / $377.55 / $2,008.57
| Professional | | $251.69 | $377.55 | $2,008.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.61 / $1,107.78 / $1,842.42
| Facility | | $281.61 | $1,107.78 | $1,842.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.57 / $424.10 / $604.35
| Professional | | $291.57 | $424.10 | $604.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.86 / $818.03 / $1,472.45
| Facility | | $330.86 | $818.03 | $1,472.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.00 / $557.25 / $696.56
| Professional | | $525.00 | $557.25 | $696.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.89 / $417.82 / $2,391.15
| Facility | | $281.89 | $417.82 | $2,391.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $211.43 / $503.40
| Professional | | $211.43 | $211.43 | $503.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $211.43 / $503.40
| Professional | | $211.43 | $211.43 | $503.40 |