- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $2,570.40
| Facility | | $371.54 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $398.11 / $3,467.37
| Professional | | $346.74 | $398.11 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,122.02
| Facility | | $446.68 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $812.83 / $851.14
| Professional | | $758.58 | $812.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $1,258.93
| Professional | | $954.99 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $776.25 / $2,454.71
| Facility | | $309.03 | $776.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $1,513.56
| Professional | | $218.78 | $309.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $1,318.26
| Professional | | $1,071.52 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $1,047.13
| Facility | | $218.78 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $309.03 / $524.81
| Professional | | $295.12 | $309.03 | $524.81 |