- 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
- $234.42 / $302.00 / $851.14
| Professional | | $234.42 | $302.00 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,801.89 / $28,840.32
| Facility | | $630.96 | $3,801.89 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $3,162.28
| Professional | | $213.80 | $407.38 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $933.25
| Professional | | $281.84 | $489.78 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $501.19 / $7,079.46
| Facility | | $102.33 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $416.87
| Professional | | $147.91 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $281.84 / $602.56
| Professional | | $120.23 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,801.89 / $28,840.32
| Facility | | $630.96 | $3,801.89 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $3,162.28
| Professional | | $213.80 | $407.38 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,912.51
| Facility | | $1,584.89 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $371.54 / $794.33
| Professional | | $213.80 | $371.54 | $794.33 |