- 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
- $331.13 / $562.34 / $1,995.26
| Professional | | $331.13 | $562.34 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,760.83 / $42,657.95
| Facility | | $56.23 | $6,760.83 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,621.81
| Professional | | $346.74 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $1,659.59
| Professional | | $588.84 | $954.99 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $8,511.38
| Facility | | $302.00 | $676.08 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $575.44 / $1,096.48
| Professional | | $478.63 | $575.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $89,125.09
| Facility | | $2,691.53 | $7,244.36 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $741.31 / $1,479.11
| Professional | | $416.87 | $741.31 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,918.31 / $42,657.95
| Facility | | $56.23 | $6,918.31 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,621.81
| Professional | | $346.74 | $707.95 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $79,432.82
| Facility | | $2,691.53 | $7,244.36 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $1,862.09
| Professional | | $537.03 | $831.76 | $1,862.09 |