- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,818.38 / $5,623.41
| Facility | | $1,122.02 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,258.93 / $2,630.27
| Professional | | $354.81 | $1,258.93 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,248.07 / $20,417.38
| Facility | | $56.23 | $5,248.07 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,412.54 / $4,265.80
| Professional | | $380.19 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $912.01
| Facility | | $389.05 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,380.38 / $3,548.13
| Professional | | $575.44 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $3,715.35
| Professional | | $416.87 | $933.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $8,511.38
| Facility | | $302.00 | $501.19 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $3,630.78
| Professional | | $1,659.59 | $2,089.30 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $3,467.37
| Professional | | $371.54 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,248.07 / $20,417.38
| Facility | | $56.23 | $5,248.07 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,412.54 / $4,265.80
| Professional | | $380.19 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,471.29
| Facility | | $2,041.74 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,548.82 / $3,630.78
| Professional | | $398.11 | $1,548.82 | $3,630.78 |