- 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
- $331.58 / $331.58 / $1,831.15
| Professional | | $331.58 | $331.58 | $1,831.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.62 / $660.62 / $660.62
| Professional | | $660.62 | $660.62 | $660.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.63 / $3,041.74 / $5,883.72
| Facility | | $2,312.63 | $3,041.74 | $5,883.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.19 / $554.29 / $739.07
| Professional | | $325.19 | $554.29 | $739.07 |
- 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
- $462.00 / $775.90 / $1,078.08
| Professional | | $462.00 | $775.90 | $1,078.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.58 / $587.95 / $2,369.15
| Facility | | $331.58 | $587.95 | $2,369.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.23 / $660.69 / $958.64
| Professional | | $415.23 | $660.69 | $958.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $892.03 / $1,597.11
| Facility | | $564.00 | $892.03 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.21 / $705.91 / $1,003.82
| Professional | | $500.21 | $705.91 | $1,003.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.23 / $675.18 / $879.74
| Professional | | $415.23 | $675.18 | $879.74 |