- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.48 / $1,417.08 / $3,539.30
| Facility | | $685.48 | $1,417.08 | $3,539.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.55 / $719.33 / $5,441.52
| Professional | | $668.55 | $719.33 | $5,441.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.93 / $3,894.96 / $8,459.92
| Facility | | $2,922.93 | $3,894.96 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.09 / $660.09 / $660.09
| Professional | | $660.09 | $660.09 | $660.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.12 / $1,249.92 / $2,807.78
| Facility | | $803.12 | $1,249.92 | $2,807.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.68 / $903.70 / $1,913.66
| Professional | | $398.68 | $903.70 | $1,913.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.53 / $1,142.46 / $2,005.39
| Professional | | $503.53 | $1,142.46 | $2,005.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.20 / $478.31 / $1,704.30
| Facility | | $211.20 | $478.31 | $1,704.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.33 / $2,301.17 / $3,495.10
| Facility | | $719.33 | $2,301.17 | $3,495.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.70 / $1,000.00 / $3,495.10
| Professional | | $634.70 | $1,000.00 | $3,495.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.48 / $1,269.40 / $1,692.54
| Professional | | $1,252.48 | $1,269.40 | $1,692.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.63 / $1,407.93 / $2,807.78
| Facility | | $823.63 | $1,407.93 | $2,807.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.83 / $905.74 / $1,913.66
| Professional | | $549.83 | $905.74 | $1,913.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $1,465.40
| Facility | | $846.27 | $846.27 | $1,465.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $1,465.40
| Professional | | $846.27 | $846.27 | $1,465.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $1,269.41
| Professional | | $355.43 | $507.76 | $1,269.41 |