- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.39 / $1,032.45 / $3,249.68
| Facility | | $592.39 | $1,032.45 | $3,249.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,000.00 / $1,200.00
| Professional | | $592.39 | $1,000.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.84 / $460.36 / $3,181.60
| Facility | | $328.84 | $460.36 | $3,181.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.48 / $887.58 / $1,445.42
| Professional | | $423.48 | $887.58 | $1,445.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $507.76 / $1,458.19
| Professional | | $507.76 | $507.76 | $1,458.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.62 / $116.80 / $159.28
| Professional | | $113.62 | $116.80 | $159.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $1,269.40
| Facility | | $846.27 | $846.27 | $1,269.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.19 / $355.43 / $1,139.08
| Professional | | $296.19 | $355.43 | $1,139.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $846.27
| Professional | | $846.27 | $846.27 | $846.27 |