- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $4,466.84
| Facility | | $660.69 | $1,318.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $758.58 / $1,148.15
| Professional | | $676.08 | $758.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,096.48 / $5,754.40
| Facility | | $1,023.29 | $1,096.48 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,000.00 / $1,318.26
| Professional | | $933.25 | $1,000.00 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,398.83 / $5,370.32
| Facility | | $602.56 | $2,398.83 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $2,137.96
| Professional | | $426.58 | $549.54 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,258.93
| Facility | | $724.44 | $891.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $933.25 / $1,122.02
| Facility | | $851.14 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $933.25
| Professional | | $389.05 | $562.34 | $933.25 |