- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $8,709.64
| Facility | | $524.81 | $776.25 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,148.15
| Professional | | $371.54 | $524.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,949.84
| Facility | | $1,905.46 | $1,905.46 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,230.27
| Professional | | $446.68 | $691.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,122.02
| Professional | | $407.38 | $602.56 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,202.26
| Professional | | $707.95 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $933.25
| Facility | | $389.05 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,258.93
| Professional | | $776.25 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $10,471.29
| Facility | | $2,187.76 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $912.01
| Professional | | $338.84 | $489.78 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $45,708.82
| Facility | | $16,595.87 | $16,595.87 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,677.35
| Professional | | $3,981.07 | $3,981.07 | $4,677.35 |