- 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
- $107.15 / $128.82 / $331.13
| Professional | | $107.15 | $128.82 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,862.09 / $28,840.32
| Facility | | $263.03 | $1,862.09 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $3,019.95
| Professional | | $102.33 | $177.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $181.97 / $295.12
| Professional | | $117.49 | $181.97 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $501.19 / $7,079.46
| Facility | | $100.00 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $134.90 / $190.55
| Professional | | $109.65 | $134.90 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $281.84
| Professional | | $102.33 | $186.21 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,862.09 / $28,840.32
| Facility | | $251.19 | $1,862.09 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $3,019.95
| Professional | | $102.33 | $177.83 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $177.83 / $323.59
| Professional | | $117.49 | $177.83 | $323.59 |