- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,202.26 / $3,090.30
| Facility | | $562.34 | $1,202.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $575.44 / $794.33
| Professional | | $537.03 | $575.44 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $3,388.44
| Facility | | $758.58 | $1,000.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $616.60 / $1,174.90
| Professional | | $239.88 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,380.38 / $3,235.94
| Facility | | $489.78 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $912.01 / $1,819.70
| Professional | | $389.05 | $912.01 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $758.58 / $912.01
| Facility | | $338.84 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $891.25
| Professional | | $316.23 | $457.09 | $891.25 |