- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $794.33 / $2,041.74
| Facility | | $346.74 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $416.87 / $588.84
| Professional | | $288.40 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $645.65
| Professional | | $331.13 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $1,737.80
| Facility | | $302.00 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $446.68 / $707.95
| Professional | | $302.00 | $446.68 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $7,079.46
| Facility | | $812.83 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $691.83
| Professional | | $275.42 | $436.52 | $691.83 |