- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $363.08 / $1,122.02
| Professional | | $309.03 | $363.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,981.07 / $45,708.82
| Facility | | $812.83 | $3,981.07 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $501.19 / $3,162.28
| Professional | | $263.03 | $501.19 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $1,174.90
| Professional | | $363.08 | $630.96 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $645.65 / $7,079.46
| Facility | | $302.00 | $645.65 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $346.74 / $512.86
| Professional | | $181.97 | $346.74 | $512.86 |
- 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
- $331.13 / $588.84 / $954.99
| Professional | | $331.13 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,265.80 / $45,708.82
| Facility | | $812.83 | $4,265.80 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $501.19 / $3,162.28
| Professional | | $263.03 | $501.19 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $1,230.27
| Professional | | $363.08 | $575.44 | $1,230.27 |