- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.22 / $1,151.68 / $2,164.66
| Facility | | $615.22 | $1,151.68 | $2,164.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.38 / $569.65 / $759.53
| Professional | | $353.38 | $569.65 | $759.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.53 / $759.53 / $1,974.78
| Facility | | $759.53 | $759.53 | $1,974.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.81 / $502.04 / $1,891.58
| Professional | | $303.81 | $502.04 | $1,891.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.72 / $759.53 / $759.53
| Facility | | $455.72 | $759.53 | $759.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.53 / $759.53 / $2,200.00
| Professional | | $759.53 | $759.53 | $2,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.74 / $1,538.31 / $2,734.18
| Facility | | $530.74 | $1,538.31 | $2,734.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.65 / $1,000.69 / $2,464.87
| Professional | | $457.65 | $1,000.69 | $2,464.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $987.39 / $1,708.94
| Facility | | $319.00 | $987.39 | $1,708.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.38 / $607.62 / $1,389.94
| Professional | | $349.38 | $607.62 | $1,389.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.55 / $721.55 / $893.96
| Professional | | $487.55 | $721.55 | $893.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.65 / $2,151.17 / $2,660.97
| Facility | | $14.65 | $2,151.17 | $2,660.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.80 / $1,610.71 / $2,734.18
| Facility | | $507.80 | $1,610.71 | $2,734.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.21 / $768.90 / $2,084.31
| Professional | | $481.21 | $768.90 | $2,084.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.36 / $372.17 / $1,139.30
| Professional | | $84.36 | $372.17 | $1,139.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.10 / $805.10 / $805.10
| Facility | | $805.10 | $805.10 | $805.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.69 / $721.55 / $893.96
| Professional | | $475.69 | $721.55 | $893.96 |