- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,311.31 / $5,623.41
| Facility | | $1,949.84 | $3,311.31 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,122.02 / $6,165.95
| Professional | | $213.80 | $1,122.02 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,025.60 / $14,454.40
| Facility | | $56.23 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,621.81 / $6,025.60
| Professional | | $223.87 | $1,621.81 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $562.34
| Facility | | $245.47 | $245.47 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,445.44 / $5,128.61
| Professional | | $371.54 | $1,445.44 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,584.89 / $5,888.44
| Professional | | $309.03 | $1,584.89 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $7,079.46
| Facility | | $177.83 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $5,370.32
| Professional | | $2,344.23 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,949.84 / $4,897.79
| Professional | | $229.09 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,772.37 / $10,471.29
| Facility | | $3,890.45 | $9,772.37 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,165.95 / $14,454.40
| Facility | | $56.23 | $6,165.95 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,621.81 / $6,025.60
| Professional | | $223.87 | $1,621.81 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $2,290.87 / $5,888.44
| Professional | | $288.40 | $2,290.87 | $5,888.44 |