- 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
- $389.05 / $501.19 / $1,380.38
| Professional | | $389.05 | $501.19 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $4,786.30
| Facility | | $56.23 | $1,778.28 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $691.83 / $3,467.37
| Professional | | $426.58 | $691.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,659.59
| Professional | | $478.63 | $776.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $954.99 / $7,079.46
| Facility | | $380.19 | $954.99 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $758.58
| Professional | | $263.03 | $512.86 | $758.58 |
- 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
- $457.09 / $812.83 / $1,202.26
| Professional | | $457.09 | $812.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $5,128.61
| Facility | | $56.23 | $1,949.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $691.83 / $3,467.37
| Professional | | $426.58 | $691.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,162.28 / $8,511.38
| Facility | | $1,202.26 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,412.54
| Professional | | $537.03 | $724.44 | $1,412.54 |