- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,090.30 / $12,589.25
| Facility | | $524.81 | $3,090.30 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $1,412.54
| Professional | | $234.42 | $457.09 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $346.74 / $562.34
| Professional | | $181.97 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $6,165.95
| Facility | | $2,454.71 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $794.33
| Professional | | $295.12 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $794.33 / $1,258.93
| Professional | | $346.74 | $794.33 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $616.60 / $1,778.28
| Facility | | $331.13 | $616.60 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $3,162.28
| Professional | | $446.68 | $794.33 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,230.27
| Professional | | $562.34 | $794.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $933.25
| Professional | | $562.34 | $794.33 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,230.27 / $4,466.84
| Facility | | $501.19 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,000.00
| Professional | | $331.13 | $575.44 | $1,000.00 |