- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $3,090.30
| Facility | | $588.84 | $812.83 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $851.14
| Professional | | $371.54 | $478.63 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $758.58 / $1,819.70
| Professional | | $436.52 | $758.58 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,187.76
| Facility | | $1,174.90 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $977.24 / $1,621.81
| Professional | | $436.52 | $977.24 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $707.95 / $3,981.07
| Facility | | $426.58 | $707.95 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,288.25
| Professional | | $776.25 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $776.25 / $8,128.31
| Facility | | $426.58 | $776.25 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $3,311.31
| Professional | | $457.09 | $954.99 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $575.44
| Professional | | $32.36 | $33.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,000.00 / $1,479.11
| Professional | | $524.81 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,754.40 / $5,754.40
| Facility | | $3,981.07 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,584.89 / $3,162.28
| Professional | | $416.87 | $1,584.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,801.89 / $4,365.16
| Professional | | $1,778.28 | $3,801.89 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,778.28
| Professional | | $389.05 | $691.83 | $1,778.28 |