- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,623.41
| Facility | | $1,778.28 | $3,311.31 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $831.76
| Professional | | $407.38 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,897.79 / $13,489.63
| Facility | | $56.23 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $912.01 / $3,890.45
| Professional | | $478.63 | $912.01 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $1,905.46
| Facility | | $50.12 | $676.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $812.83 / $1,698.24
| Professional | | $407.38 | $812.83 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,168.69 / $8,511.38
| Facility | | $83.18 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $912.01
| Professional | | $776.25 | $776.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $912.01 / $1,513.56
| Professional | | $501.19 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,897.79 / $13,489.63
| Facility | | $56.23 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $912.01 / $3,890.45
| Professional | | $478.63 | $912.01 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $15,135.61
| Facility | | $1,584.89 | $5,370.32 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $912.01 / $1,862.09
| Professional | | $478.63 | $912.01 | $1,862.09 |