- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,949.84 / $2,754.23
| Facility | | $512.86 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,348.96
| Professional | | $371.54 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $346.74 / $346.74
| Professional | | $138.04 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,148.15 / $1,698.24
| Facility | | $354.81 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $549.54 / $1,047.13
| Professional | | $537.03 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $467.74 / $1,819.70
| Facility | | $120.23 | $467.74 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $2,454.71
| Professional | | $245.47 | $363.08 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,000.00
| Facility | | $407.38 | $616.60 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $2,754.23
| Professional | | $234.42 | $234.42 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $562.34 / $660.69
| Facility | | $501.19 | $562.34 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $331.13
| Professional | | $234.42 | $234.42 | $331.13 |