- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $5,128.61
| Facility | | $1,737.80 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $1,513.56 / $3,890.45
| Professional | | $144.54 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $11,220.18
| Facility | | $56.23 | $2,884.03 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,348.96 / $5,888.44
| Professional | | $154.88 | $1,348.96 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $389.05
| Facility | | $165.96 | $165.96 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $3,388.44
| Professional | | $281.84 | $281.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $645.65 / $5,888.44
| Professional | | $190.55 | $645.65 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $7,079.46
| Facility | | $123.03 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $4,466.84
| Professional | | $1,862.09 | $2,398.83 | $4,466.84 |
- 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
- $147.91 / $1,621.81 / $4,073.80
| Professional | | $147.91 | $1,621.81 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $11,220.18
| Facility | | $56.23 | $2,884.03 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,348.96 / $5,888.44
| Professional | | $154.88 | $1,348.96 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $12,302.69
| Facility | | $1,905.46 | $4,570.88 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $1,737.80 / $6,165.95
| Professional | | $186.21 | $1,737.80 | $6,165.95 |