- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,047.13 / $1,995.26
| Facility | | $436.52 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,023.29
| Professional | | $436.52 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,202.26
| Professional | | $891.25 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $954.99 / $2,290.87
| Facility | | $870.96 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $1,071.52
| Professional | | $549.54 | $794.33 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,548.82 / $3,235.94
| Facility | | $616.60 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $1,122.02
| Professional | | $436.52 | $562.34 | $1,122.02 |