- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,388.44 / $5,495.41
| Facility | | $1,584.89 | $3,388.44 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,479.11
| Professional | | $645.65 | $870.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,737.80 / $3,981.07
| Facility | | $630.96 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $1,513.56
| Professional | | $1,047.13 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,288.25
| Professional | | $724.44 | $977.24 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,071.52 / $1,905.46
| Facility | | $645.65 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,318.26 / $1,584.89
| Professional | | $1,023.29 | $1,318.26 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $4,786.30
| Facility | | $2,754.23 | $3,467.37 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $1,621.81
| Professional | | $891.25 | $1,288.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,148.15 / $2,630.27
| Professional | | $691.83 | $1,148.15 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,467.37 / $7,762.47
| Facility | | $676.08 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $1,445.44
| Professional | | $676.08 | $1,000.00 | $1,445.44 |