- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.68 / $857.44 / $2,987.23
| Facility | | $334.68 | $857.44 | $2,987.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $400.00 / $425.00
| Professional | | $318.75 | $400.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.45 / $975.64 / $1,808.43
| Facility | | $440.45 | $975.64 | $1,808.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,338.15 / $1,338.15
| Professional | | $1,338.15 | $1,338.15 | $1,338.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.58 / $1,204.42 / $3,831.61
| Facility | | $677.58 | $1,204.42 | $3,831.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.13 / $1,421.00 / $3,060.00
| Facility | | $361.13 | $1,421.00 | $3,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $425.00 / $1,037.00
| Professional | | $318.75 | $425.00 | $1,037.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.37 / $952.87 / $1,808.43
| Facility | | $422.37 | $952.87 | $1,808.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,338.15 / $1,338.15
| Professional | | $1,338.15 | $1,338.15 | $1,338.15 |