- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $14,454.40
| Facility | | $741.31 | $1,548.82 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $776.25 / $1,949.84
| Professional | | $691.83 | $776.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,513.56 / $3,890.45
| Professional | | $741.31 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $3,890.45
| Facility | | $1,949.84 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $3,090.30 / $3,467.37
| Professional | | $933.25 | $3,090.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,479.11 / $3,981.07
| Facility | | $741.31 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,819.70 / $2,344.23
| Professional | | $1,348.96 | $1,819.70 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $15,135.61
| Facility | | $741.31 | $1,548.82 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,318.26 / $5,623.41
| Professional | | $724.44 | $1,318.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $85.11
| Professional | | $32.36 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,698.24 / $2,630.27
| Professional | | $1,122.02 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $18,197.01 / $26,915.35
| Facility | | $9,772.37 | $18,197.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $5,495.41
| Professional | | $1,348.96 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,168.69 / $4,786.30
| Professional | | $2,187.76 | $4,168.69 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,071.52 / $3,090.30
| Professional | | $724.44 | $1,071.52 | $3,090.30 |