- 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
- $251.19 / $309.03 / $812.83
| Professional | | $251.19 | $309.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,128.61 / $28,840.32
| Facility | | $660.69 | $5,128.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $1,995.26
| Professional | | $213.80 | $407.38 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $954.99
| Professional | | $295.12 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $7,079.46
| Facility | | $251.19 | $512.86 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $281.84 / $416.87
| Professional | | $147.91 | $281.84 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $758.58
| Professional | | $263.03 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,370.32 / $28,840.32
| Facility | | $660.69 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $1,995.26
| Professional | | $213.80 | $407.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $1,000.00
| Professional | | $295.12 | $436.52 | $1,000.00 |