- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.07 / $1,853.46 / $1,853.46
| Facility | | $536.07 | $1,853.46 | $1,853.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.82 / $502.71 / $643.28
| Professional | | $388.82 | $502.71 | $643.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.23 / $641.37 / $1,622.44
| Professional | | $421.23 | $641.37 | $1,622.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.43 / $1,529.00 / $2,345.52
| Facility | | $1,308.43 | $1,529.00 | $2,345.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.52 / $1,124.66 / $1,662.62
| Professional | | $491.52 | $1,124.66 | $1,662.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.10 / $536.07 / $981.49
| Facility | | $452.10 | $536.07 | $981.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.66 / $536.07 / $1,013.21
| Facility | | $455.66 | $536.07 | $1,013.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.23 / $742.78 / $3,624.69
| Professional | | $449.23 | $742.78 | $3,624.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.24 / $486.13 / $1,010.24
| Professional | | $286.24 | $486.13 | $1,010.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.10 / $533.03 / $993.75
| Facility | | $452.10 | $533.03 | $993.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.13 / $1,149.24 / $1,639.00
| Professional | | $811.13 | $1,149.24 | $1,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.26 / $1,003.00 / $2,255.57
| Facility | | $569.26 | $1,003.00 | $2,255.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.97 / $2,147.65 / $3,624.69
| Professional | | $555.97 | $2,147.65 | $3,624.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.83 / $841.89 / $1,745.53
| Professional | | $598.83 | $841.89 | $1,745.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.53 / $660.92 / $1,580.94
| Professional | | $429.53 | $660.92 | $1,580.94 |