- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.57 / $728.28 / $1,077.84
| Facility | | $718.57 | $728.28 | $1,077.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.57 / $728.28 / $1,163.85
| Professional | | $718.57 | $728.28 | $1,163.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $711.17 / $1,583.98
| Facility | | $22.34 | $711.17 | $1,583.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.35 / $816.00 / $1,693.30
| Professional | | $502.35 | $816.00 | $1,693.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.28 / $1,268.35 / $7,207.17
| Facility | | $728.28 | $1,268.35 | $7,207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.06 / $494.56 / $1,297.84
| Professional | | $428.06 | $494.56 | $1,297.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.06 / $431.84 / $777.11
| Professional | | $428.06 | $431.84 | $777.11 |