- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,071.52 / $2,630.27
| Facility | | $457.09 | $1,071.52 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,905.46
| Professional | | $346.74 | $524.81 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $45,708.82
| Facility | | $457.09 | $512.86 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $1,000.00
| Professional | | $389.05 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,630.78 / $50,118.72
| Facility | | $691.83 | $3,630.78 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $630.96 / $1,202.26
| Professional | | $380.19 | $630.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $416.87 / $549.54
| Facility | | $288.40 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $912.01
| Professional | | $354.81 | $501.19 | $912.01 |