- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $912.01 / $2,344.23
| Facility | | $436.52 | $912.01 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $758.58
| Professional | | $346.74 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $2,398.83
| Facility | | $512.86 | $707.95 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $851.14
| Professional | | $208.93 | $257.04 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,000.00 / $2,290.87
| Facility | | $338.84 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $602.56 / $1,230.27
| Professional | | $245.47 | $602.56 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $616.60
| Facility | | $309.03 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $676.08
| Professional | | $218.78 | $309.03 | $676.08 |