- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.29 / $687.60 / $2,206.30
| Facility | | $490.29 | $687.60 | $2,206.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.43 / $472.35 / $538.12
| Professional | | $448.43 | $472.35 | $538.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.35 / $535.13 / $1,793.73
| Facility | | $472.35 | $535.13 | $1,793.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $239.16 / $800.00
| Professional | | $100.00 | $239.16 | $800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.91 / $717.49 / $837.07
| Facility | | $597.91 | $717.49 | $837.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $687.60 / $866.97
| Professional | | $597.91 | $687.60 | $866.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.64 / $597.91 / $1,391.00
| Facility | | $388.64 | $597.91 | $1,391.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.76 / $588.44 / $858.52
| Professional | | $274.76 | $588.44 | $858.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $251.12 / $597.91
| Professional | | $48.96 | $251.12 | $597.91 |