- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $2,454.71
| Facility | | $436.52 | $933.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $851.14
| Professional | | $354.81 | $436.52 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $2,238.72
| Facility | | $478.63 | $645.65 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $1,096.48
| Professional | | $239.88 | $316.23 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,000.00 / $2,238.72
| Facility | | $331.13 | $1,000.00 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $588.84 / $1,202.26
| Professional | | $295.12 | $588.84 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $489.78 / $707.95
| Facility | | $288.40 | $489.78 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $741.31
| Professional | | $204.17 | $295.12 | $741.31 |