- 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 / $446.68 / $1,047.13
| Professional | | $354.81 | $446.68 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $7,413.10 / $45,708.82
| Facility | | $912.01 | $7,413.10 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $3,981.07
| Professional | | $363.08 | $645.65 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,047.13
| Professional | | $457.09 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,096.48
| Professional | | $389.05 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $794.33 / $7,079.46
| Facility | | $371.54 | $794.33 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $707.95
| Professional | | $407.38 | $512.86 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $691.83 / $1,122.02
| Professional | | $380.19 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $7,413.10 / $45,708.82
| Facility | | $912.01 | $7,413.10 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $3,981.07
| Professional | | $363.08 | $645.65 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,122.02
| Professional | | $426.58 | $660.69 | $1,122.02 |