- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,090.30 / $4,365.16
| Facility | | $524.81 | $3,090.30 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $524.81 / $977.24
| Professional | | $446.68 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,513.56
| Professional | | $891.25 | $1,202.26 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,202.26
| Facility | | $645.65 | $851.14 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $3,801.89
| Professional | | $446.68 | $758.58 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $1,071.52
| Professional | | $933.25 | $1,047.13 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,000.00
| Professional | | $933.25 | $933.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,000.00
| Professional | | $512.86 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $870.96 / $1,348.96
| Professional | | $489.78 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,230.27
| Professional | | $1,000.00 | $1,174.90 | $1,230.27 |