- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $1,230.27
| Professional | | $416.87 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $8,912.51
| Facility | | $56.23 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $3,890.45
| Professional | | $436.52 | $707.95 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,949.84 / $1,949.84
| Professional | | $446.68 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $741.31 / $3,548.13
| Facility | | $100.00 | $741.31 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $1,258.93
| Professional | | $389.05 | $645.65 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $933.25 / $7,079.46
| Facility | | $380.19 | $933.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $933.25
| Professional | | $457.09 | $630.96 | $933.25 |
- 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
- $446.68 / $812.83 / $1,258.93
| Professional | | $446.68 | $812.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $8,912.51
| Facility | | $56.23 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $3,890.45
| Professional | | $436.52 | $691.83 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,570.88 / $9,332.54
| Facility | | $1,479.11 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,318.26
| Professional | | $436.52 | $660.69 | $1,318.26 |