- 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
- $269.15 / $316.23 / $812.83
| Professional | | $269.15 | $316.23 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,248.07 / $28,840.32
| Facility | | $630.96 | $5,248.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $467.74 / $2,041.74
| Professional | | $263.03 | $467.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,187.76 / $2,187.76
| Professional | | $602.56 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $6,025.60
| Facility | | $588.84 | $645.65 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $416.87 / $831.76
| Professional | | $223.87 | $416.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $537.03 / $7,079.46
| Facility | | $257.04 | $537.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $616.60
| Professional | | $269.15 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,570.88 / $11,220.18
| Facility | | $645.65 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $478.63 / $741.31
| Professional | | $269.15 | $478.63 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,248.07 / $28,840.32
| Facility | | $630.96 | $5,248.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $2,041.74
| Professional | | $269.15 | $467.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,011.87 / $12,022.64
| Facility | | $1,479.11 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $776.25
| Professional | | $275.42 | $457.09 | $776.25 |