- 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 / $478.63 / $1,230.27
| Professional | | $389.05 | $478.63 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,630.78 / $28,840.32
| Facility | | $954.99 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $3,090.30
| Professional | | $380.19 | $660.69 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,122.02
| Professional | | $446.68 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $7,079.46
| Facility | | $436.52 | $933.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $831.76
| Professional | | $478.63 | $602.56 | $831.76 |
- 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
- $446.68 / $831.76 / $1,348.96
| Professional | | $446.68 | $831.76 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,630.78 / $28,840.32
| Facility | | $1,000.00 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $3,090.30
| Professional | | $380.19 | $660.69 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,348.96
| Professional | | $416.87 | $660.69 | $1,348.96 |