- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,089.30 / $2,089.30
| Facility | | $912.01 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $912.01
| Professional | | $537.03 | $616.60 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $2,089.30
| Facility | | $1,621.81 | $2,041.74 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $2,754.23
| Professional | | $257.04 | $302.00 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,454.71 / $3,890.45
| Facility | | $2,089.30 | $2,454.71 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,905.46 / $2,398.83
| Professional | | $870.96 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,090.30 / $4,466.84
| Facility | | $776.25 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $5,011.87
| Professional | | $4,570.88 | $4,570.88 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $2,630.27
| Facility | | $691.83 | $977.24 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $3,801.89
| Professional | | $338.84 | $457.09 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $380.19
| Professional | | $50.12 | $64.57 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,778.28 / $2,511.89
| Professional | | $1,230.27 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $3,630.78
| Facility | | $1,513.56 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,801.89 / $3,801.89
| Professional | | $1,096.48 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,168.69 / $5,754.40
| Professional | | $2,187.76 | $4,168.69 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $912.01
| Facility | | $602.56 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $1,258.93
| Professional | | $316.23 | $457.09 | $1,258.93 |