- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $501.19 / $1,412.54
| Professional | | $239.88 | $501.19 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,888.44 / $28,840.32
| Facility | | $1,000.00 | $5,888.44 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $2,951.21
| Professional | | $323.59 | $575.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,548.82
| Professional | | $537.03 | $851.14 | $1,548.82 |
- 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
- $489.78 / $588.84 / $794.33
| Professional | | $489.78 | $588.84 | $794.33 |
- 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
- $416.87 / $741.31 / $1,288.25
| Professional | | $416.87 | $741.31 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,888.44 / $28,840.32
| Facility | | $1,000.00 | $5,888.44 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $2,951.21
| Professional | | $323.59 | $575.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $11,220.18
| Facility | | $2,041.74 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,737.80
| Professional | | $436.52 | $630.96 | $1,737.80 |