- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $8,317.64
| Facility | | $1,047.13 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $346.74 / $1,023.29
| Professional | | $288.40 | $346.74 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,606.93 / $57,543.99
| Facility | | $6,456.54 | $6,606.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $602.56
| Professional | | $489.78 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $630.96
| Professional | | $295.12 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $478.63
| Professional | | $338.84 | $436.52 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $630.96
| Professional | | $309.03 | $416.87 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,691.53 / $8,317.64
| Facility | | $912.01 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $1,071.52
| Professional | | $295.12 | $426.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $630.96
| Facility | | $501.19 | $501.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $676.08
| Professional | | $416.87 | $501.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $457.09
| Facility | | $309.03 | $416.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $457.09
| Professional | | $309.03 | $416.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $10,964.78
| Facility | | $1,348.96 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $645.65
| Professional | | $281.84 | $380.19 | $645.65 |