- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $5,128.61
| Facility | | $1,513.56 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $398.11 / $1,023.29
| Professional | | $338.84 | $398.11 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,981.07 / $28,840.32
| Facility | | $812.83 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $2,818.38
| Professional | | $346.74 | $562.34 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,454.71 / $2,454.71
| Professional | | $602.56 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $1,905.46
| Facility | | $588.84 | $645.65 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $1,023.29
| Professional | | $309.03 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $660.69 / $7,079.46
| Facility | | $316.23 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $776.25
| Professional | | $331.13 | $467.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $891.25
| Professional | | $331.13 | $588.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,981.07 / $28,840.32
| Facility | | $812.83 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $2,818.38
| Professional | | $346.74 | $562.34 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,801.89 / $8,709.64
| Facility | | $1,071.52 | $3,801.89 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $977.24
| Professional | | $346.74 | $562.34 | $977.24 |