- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.53 / $340.53 / $1,852.41
| Professional | | $340.53 | $340.53 | $1,852.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.33 / $309.33 / $309.33
| Professional | | $309.33 | $309.33 | $309.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.88 / $564.00 / $752.00
| Professional | | $330.88 | $564.00 | $752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.43 / $830.82 / $1,073.21
| Professional | | $668.43 | $830.82 | $1,073.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.53 / $595.92 / $4,217.00
| Facility | | $340.53 | $595.92 | $4,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.96 / $722.49 / $971.07
| Professional | | $425.96 | $722.49 | $971.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.50 / $953.00 / $1,597.29
| Facility | | $689.50 | $953.00 | $1,597.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.39 / $791.83 / $1,035.64
| Professional | | $586.39 | $791.83 | $1,035.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.96 / $704.47 / $917.45
| Professional | | $425.96 | $704.47 | $917.45 |