- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $891.25 / $2,454.71
| Facility | | $446.68 | $891.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $1,000.00
| Professional | | $407.38 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $10,232.93
| Facility | | $223.87 | $263.03 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,174.90
| Professional | | $446.68 | $602.56 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $741.31 / $1,995.26
| Facility | | $316.23 | $741.31 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,548.82
| Professional | | $467.74 | $776.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $691.83 / $2,041.74
| Facility | | $426.58 | $691.83 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $1,148.15
| Professional | | $416.87 | $616.60 | $1,148.15 |