- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.34 / $543.24 / $1,501.52
| Facility | | $475.34 | $543.24 | $1,501.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.57 / $782.37 / $1,139.97
| Professional | | $451.57 | $782.37 | $1,139.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.56 / $1,303.95 / $1,303.95
| Professional | | $471.56 | $1,303.95 | $1,303.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.33 / $2,256.29 / $2,544.67
| Facility | | $1,150.33 | $2,256.29 | $2,544.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $1,043.16 / $2,086.32
| Professional | | $75.00 | $1,043.16 | $2,086.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.30 / $990.81 / $1,782.82
| Facility | | $713.30 | $990.81 | $1,782.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.07 / $756.11 / $1,498.36
| Professional | | $315.07 | $756.11 | $1,498.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.66 / $831.33 / $1,054.94
| Facility | | $529.66 | $831.33 | $1,054.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.59 / $931.48 / $1,500.00
| Professional | | $702.59 | $931.48 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.05 / $716.40 / $2,497.06
| Professional | | $679.05 | $716.40 | $2,497.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.89 / $890.31 / $1,117.78
| Facility | | $558.89 | $890.31 | $1,117.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.53 / $465.74 / $931.48
| Professional | | $339.53 | $465.74 | $931.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.16 / $6,193.76 / $6,193.76
| Facility | | $2,034.16 | $6,193.76 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,493.67 / $6,493.67 / $9,779.62
| Professional | | $6,493.67 | $6,493.67 | $9,779.62 |