- 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
- $354.81 / $457.09 / $1,174.90
| Professional | | $354.81 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,344.23 / $28,840.32
| Facility | | $616.60 | $2,344.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $3,019.95
| Professional | | $389.05 | $616.60 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $724.44
| Professional | | $602.56 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $1,412.54
| Facility | | $588.84 | $645.65 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,148.15
| Professional | | $323.59 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $7,079.46
| Facility | | $416.87 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $870.96
| Professional | | $436.52 | $616.60 | $870.96 |
- 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
- $426.58 / $776.25 / $1,202.26
| Professional | | $426.58 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,344.23 / $28,840.32
| Facility | | $616.60 | $2,344.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $3,019.95
| Professional | | $389.05 | $602.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | | $676.08 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,258.93
| Professional | | $389.05 | $588.84 | $1,258.93 |