- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,862.09 / $5,888.44
| Facility | | $851.14 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,318.26
| Professional | | $741.31 | $1,000.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,041.74 / $5,754.40
| Facility | | $741.31 | $2,041.74 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,584.89 / $1,905.46
| Professional | | $588.84 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,772.37 / $9,772.37
| Professional | | $6,456.54 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $2,570.40
| Facility | | $912.01 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,513.56
| Professional | | $776.25 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,412.54 / $2,754.23
| Professional | | $1,318.26 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $3,630.78
| Facility | | $851.14 | $1,318.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,380.38 / $2,290.87
| Professional | | $588.84 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $1,318.26
| Facility | | $467.74 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $776.25
| Professional | | $467.74 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,318.26 / $1,318.26
| Professional | | $436.52 | $1,318.26 | $1,318.26 |