- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.24 / $1,305.57 / $2,337.87
| Facility | | $607.24 | $1,305.57 | $2,337.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $607.24 / $622.41
| Professional | | $531.34 | $607.24 | $622.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.00 / $761.10 / $1,361.72
| Professional | | $555.00 | $761.10 | $1,361.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.61 / $1,027.22 / $16,067.93
| Facility | | $691.61 | $1,027.22 | $16,067.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.61 / $1,037.42 / $17,856.50
| Professional | | $691.61 | $1,037.42 | $17,856.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.42 / $1,598.55 / $5,117.39
| Facility | | $863.42 | $1,598.55 | $5,117.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.42 / $1,598.55 / $5,117.39
| Facility | | $863.42 | $1,598.55 | $5,117.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $759.05
| Facility | | $759.05 | $759.05 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $1,002.48
| Professional | | $318.80 | $455.43 | $1,002.48 |