- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.72 / $315.49 / $1,711.24
| Professional | | $277.72 | $315.49 | $1,711.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,063.17 / $11,728.12
| Facility | | $4,609.82 | $6,063.17 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.61 / $517.51 / $690.02
| Professional | | $303.61 | $517.51 | $690.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $747.28 / $1,001.80
| Professional | | $494.00 | $747.28 | $1,001.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.49 / $567.88 / $5,405.32
| Facility | | $315.49 | $567.88 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.05 / $678.15 / $915.18
| Professional | | $410.05 | $678.15 | $915.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.00 / $839.40 / $2,961.89
| Facility | | $605.00 | $839.40 | $2,961.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.04 / $724.37 / $1,001.80
| Professional | | $505.04 | $724.37 | $1,001.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.70 / $580.86 / $3,254.15
| Professional | | $309.70 | $580.86 | $3,254.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.05 / $678.15 / $883.18
| Professional | | $410.05 | $678.15 | $883.18 |