- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,090.30 / $3,715.35
| Facility | | $389.05 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,479.11 / $3,548.13
| Professional | | $331.13 | $1,479.11 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,584.89
| Facility | | $1,202.26 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,862.09 / $7,244.36
| Professional | | $457.09 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $8,912.51
| Facility | | $4,786.30 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,479.11 / $6,456.54
| Professional | | $407.38 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,737.80 / $3,715.35
| Facility | | $363.08 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,071.52 / $5,370.32
| Professional | | $616.60 | $1,071.52 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,202.26 / $3,548.13
| Facility | | $371.54 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $13,182.57
| Professional | | $1,949.84 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,187.76 / $6,456.54
| Professional | | $588.84 | $2,187.76 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $8,709.64 / $8,709.64
| Facility | | $812.83 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $9,120.11 / $13,182.57
| Professional | | $549.54 | $9,120.11 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,454.71 / $12,589.25
| Professional | | $1,479.11 | $2,454.71 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,137.96
| Facility | | $1,023.29 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,737.80 / $6,606.93
| Professional | | $380.19 | $1,737.80 | $6,606.93 |