- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.19 / $2,663.12 / $4,806.64
| Facility | | $729.19 | $2,663.12 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.64 / $729.19 / $2,306.52
| Professional | | $273.64 | $729.19 | $2,306.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,372.00 / $10,821.00
| Facility | | $818.35 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.81 / $1,375.32 / $6,860.64
| Professional | | $430.81 | $1,375.32 | $6,860.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.39 / $646.61 / $1,268.33
| Facility | | $497.39 | $646.61 | $1,268.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.67 / $815.67 / $1,952.97
| Professional | | $815.67 | $815.67 | $1,952.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.17 / $1,310.22 / $2,908.52
| Professional | | $539.17 | $1,310.22 | $2,908.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.83 / $906.94 / $6,679.00
| Facility | | $413.83 | $906.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.97 / $1,412.69 / $2,205.61
| Professional | | $1,117.97 | $1,412.69 | $2,205.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.92 / $1,175.14 / $2,608.92
| Professional | | $518.92 | $1,175.14 | $2,608.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.52 / $331.52 / $3,485.22
| Facility | | $331.52 | $331.52 | $3,485.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.79 / $857.23 / $1,085.59
| Professional | | $542.79 | $857.23 | $1,085.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,649.00 / $26,542.00
| Facility | | $1,640.00 | $3,649.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.00 / $2,460.54 / $6,860.64
| Professional | | $843.00 | $2,460.54 | $6,860.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.94 / $1,506.40 / $3,070.74
| Professional | | $683.94 | $1,506.40 | $3,070.74 |