- 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
- $436.52 / $524.81 / $1,513.56
| Professional | | $436.52 | $524.81 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,128.61 / $28,840.32
| Facility | | $1,122.02 | $5,128.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $724.44 / $4,466.84
| Professional | | $380.19 | $724.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $1,737.80
| Professional | | $512.86 | $912.01 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $954.99 / $7,079.46
| Facility | | $446.68 | $954.99 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $776.25
| Professional | | $269.15 | $512.86 | $776.25 |
- 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
- $457.09 / $870.96 / $1,412.54
| Professional | | $457.09 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,370.32 / $28,840.32
| Facility | | $1,174.90 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $724.44 / $4,466.84
| Professional | | $380.19 | $724.44 | $4,466.84 |
- 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
- $524.81 / $758.58 / $1,905.46
| Professional | | $524.81 | $758.58 | $1,905.46 |