- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.67 / $3,489.13 / $12,036.14
| Facility | | $1,139.67 | $3,489.13 | $12,036.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.90 / $747.61 / $1,474.15
| Professional | | $359.90 | $747.61 | $1,474.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.45 / $1,263.20 / $1,486.91
| Professional | | $777.45 | $1,263.20 | $1,486.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.32 / $492.33 / $952.33
| Facility | | $374.32 | $492.33 | $952.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.25 / $668.91 / $1,269.17
| Professional | | $346.25 | $668.91 | $1,269.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.42 / $1,094.47 / $1,979.89
| Professional | | $686.42 | $1,094.47 | $1,979.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.60 / $946.68 / $1,775.00
| Facility | | $520.60 | $946.68 | $1,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.03 / $1,327.89 / $2,637.28
| Professional | | $788.03 | $1,327.89 | $2,637.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.51 / $995.07 / $1,712.61
| Facility | | $574.51 | $995.07 | $1,712.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.46 / $1,233.63 / $1,766.45
| Professional | | $771.46 | $1,233.63 | $1,766.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.49 / $713.98 / $1,373.04
| Professional | | $372.49 | $713.98 | $1,373.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.03 / $1,344.65 / $1,600.91
| Professional | | $788.03 | $1,344.65 | $1,600.91 |