- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,456.54 / $12,589.25
| Facility | | $1,949.84 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $457.09 / $1,047.13
| Professional | | $257.04 | $457.09 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $407.38 / $794.33
| Professional | | $389.05 | $407.38 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $6,165.95
| Facility | | $2,454.71 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $776.25
| Professional | | $316.23 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $812.83 / $1,230.27
| Professional | | $346.74 | $812.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $1,778.28
| Facility | | $331.13 | $602.56 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $5,888.44
| Professional | | $501.19 | $851.14 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,230.27
| Professional | | $602.56 | $851.14 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $933.25
| Professional | | $616.60 | $851.14 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $4,466.84
| Facility | | $912.01 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,000.00
| Professional | | $354.81 | $602.56 | $1,000.00 |