- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.45 / $3,893.21 / $6,978.40
| Facility | | $1,276.45 | $3,893.21 | $6,978.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.21 / $600.00 / $2,448.56
| Professional | | $508.21 | $600.00 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $6,366.26
| Facility | | $2,448.56 | $2,448.56 | $6,366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.42 / $1,126.33 / $3,804.57
| Professional | | $979.42 | $1,126.33 | $3,804.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.14 / $2,448.56 / $2,448.56
| Facility | | $1,469.14 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,787.45 / $2,448.56 / $2,448.56
| Professional | | $1,787.45 | $2,448.56 | $2,448.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,710.97 / $4,958.35 / $6,353.63
| Facility | | $1,710.97 | $4,958.35 | $6,353.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.41 / $2,950.67 / $7,946.01
| Professional | | $939.41 | $2,950.67 | $7,946.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $904.27 / $5,509.26
| Facility | | $332.00 | $904.27 | $5,509.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.33 / $1,958.85 / $4,480.85
| Professional | | $1,126.33 | $1,958.85 | $4,480.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.21 / $2,326.13 / $2,881.95
| Professional | | $398.21 | $2,326.13 | $2,881.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $5,172.57 / $6,353.63
| Facility | | $555.00 | $5,172.57 | $6,353.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.41 / $1,836.42 / $6,718.29
| Professional | | $939.41 | $1,836.42 | $6,718.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.10 / $1,101.84 / $3,672.84
| Professional | | $602.10 | $1,101.84 | $3,672.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.43 / $2,595.48 / $2,595.48
| Facility | | $808.43 | $2,595.48 | $2,595.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.50 / $2,326.13 / $2,881.95
| Professional | | $386.50 | $2,326.13 | $2,881.95 |