- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,047.13 / $2,754.23
| Facility | | $407.38 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $512.86
| Professional | | $346.74 | $407.38 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,071.52 / $1,621.81
| Facility | | $331.13 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $1,000.00
| Professional | | $501.19 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $1,479.11
| Facility | | $302.00 | $407.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $977.24
| Facility | | $354.81 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $2,630.27
| Professional | | $223.87 | $223.87 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $630.96
| Facility | | $478.63 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $316.23
| Professional | | $223.87 | $223.87 | $316.23 |