- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,818.38 / $5,128.61
| Facility | | $645.65 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,380.38
| Professional | | $467.74 | $660.69 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,265.80 / $28,840.32
| Facility | | $1,122.02 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $2,041.74
| Professional | | $489.78 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,288.25
| Facility | | $562.34 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,412.54 / $1,412.54
| Professional | | $602.56 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,000.00 / $1,819.70
| Professional | | $549.54 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $912.01 / $7,079.46
| Facility | | $426.58 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,258.93
| Professional | | $724.44 | $933.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,698.24
| Professional | | $501.19 | $794.33 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,265.80 / $28,840.32
| Facility | | $1,122.02 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,995.26
| Professional | | $489.78 | $794.33 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,120.11
| Facility | | $1,698.24 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,698.24
| Professional | | $501.19 | $831.76 | $1,698.24 |