- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.67 / $1,227.20 / $14,464.32
| Facility | | $611.67 | $1,227.20 | $14,464.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.25 / $611.67 / $1,186.76
| Professional | | $436.25 | $611.67 | $1,186.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.24 / $8,052.47 / $15,403.47
| Facility | | $2,009.24 | $8,052.47 | $15,403.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.12 / $1,068.91 / $3,948.83
| Professional | | $631.12 | $1,068.91 | $3,948.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.80 / $1,708.80 / $2,846.84
| Facility | | $1,708.80 | $1,708.80 | $2,846.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.36 / $920.83 / $1,385.08
| Professional | | $563.36 | $920.83 | $1,385.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.61 / $948.30 / $2,421.55
| Facility | | $527.61 | $948.30 | $2,421.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.11 / $940.55 / $1,395.01
| Professional | | $555.11 | $940.55 | $1,395.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.27 / $395.83 / $1,082.45
| Professional | | $82.27 | $395.83 | $1,082.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.21 / $862.99 / $925.27
| Facility | | $634.21 | $862.99 | $925.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.83 / $631.12 / $1,048.55
| Facility | | $608.83 | $631.12 | $1,048.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.12 / $994.56 / $1,235.82
| Professional | | $631.12 | $994.56 | $1,235.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,221.67 / $8,047.87 / $15,403.47
| Facility | | $5,221.67 | $8,047.87 | $15,403.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.92 / $884.25 / $1,154.19
| Professional | | $620.92 | $884.25 | $1,154.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $2,548.46 / $10,522.00
| Facility | | $1,862.00 | $2,548.46 | $10,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.52 / $887.89 / $1,310.19
| Professional | | $575.52 | $887.89 | $1,310.19 |