- 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
- $144.54 / $162.18 / $436.52
| Professional | | $144.54 | $162.18 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $6,456.54
| Facility | | $56.23 | $1,949.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $1,096.48
| Professional | | $144.54 | $234.42 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $2,454.71 / $2,454.71
| Professional | | $537.03 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $2,511.89
| Facility | | $676.08 | $741.31 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $446.68
| Professional | | $154.88 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $288.40 / $8,511.38
| Facility | | $134.90 | $288.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $194.98 / $269.15
| Professional | | $138.04 | $194.98 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $389.05
| Professional | | $141.25 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $6,456.54
| Facility | | $56.23 | $1,949.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $1,096.48
| Professional | | $147.91 | $234.42 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,467.37 / $8,511.38
| Facility | | $676.08 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $426.58
| Professional | | $147.91 | $234.42 | $426.58 |