- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $1,047.13
| Professional | | $354.81 | $436.52 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,235.94 / $45,708.82
| Facility | | $977.24 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $3,019.95
| Professional | | $363.08 | $616.60 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,148.15
| Professional | | $407.38 | $616.60 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $891.25 / $7,079.46
| Facility | | $407.38 | $891.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $776.25
| Professional | | $457.09 | $562.34 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $758.58 / $1,202.26
| Professional | | $407.38 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,235.94 / $45,708.82
| Facility | | $977.24 | $3,235.94 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $3,019.95
| Professional | | $363.08 | $616.60 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,258.93
| Professional | | $398.11 | $616.60 | $1,258.93 |