- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $6,732.07 / $16,762.57
| Facility | | $1,615.00 | $6,732.07 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.64 / $364.72 / $1,556.10
| Professional | | $292.64 | $364.72 | $1,556.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.37 / $385.58 / $655.13
| Professional | | $237.37 | $385.58 | $655.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.05 / $533.62 / $711.49
| Professional | | $313.05 | $533.62 | $711.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.00 / $782.90 / $1,021.59
| Professional | | $614.00 | $782.90 | $1,021.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.85 / $595.41 / $4,217.00
| Facility | | $321.85 | $595.41 | $4,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.85 / $681.14 / $943.99
| Professional | | $411.85 | $681.14 | $943.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $945.18 / $1,597.11
| Facility | | $637.00 | $945.18 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.99 / $743.27 / $1,003.16
| Professional | | $567.99 | $743.27 | $1,003.16 |
- 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
- $411.85 / $617.78 / $887.07
| Professional | | $411.85 | $617.78 | $887.07 |