- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.00 / $5,463.36 / $13,841.56
| Facility | | $1,545.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.49 / $239.19 / $854.47
| Professional | | $150.49 | $239.19 | $854.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.36 / $194.36 / $194.36
| Professional | | $194.36 | $194.36 | $194.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.95 / $4,502.10 / $8,708.54
| Facility | | $3,422.95 | $4,502.10 | $8,708.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.15 / $288.62 / $414.79
| Professional | | $160.15 | $288.62 | $414.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.64 / $484.11 / $645.67
| Professional | | $185.64 | $484.11 | $645.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.79 / $359.06 / $2,699.21
| Facility | | $176.79 | $359.06 | $2,699.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.73 / $444.90 / $1,665.36
| Professional | | $260.73 | $444.90 | $1,665.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.08 / $497.33 / $1,311.70
| Facility | | $366.08 | $497.33 | $1,311.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.94 / $420.53 / $575.08
| Professional | | $310.94 | $420.53 | $575.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.84 / $283.60 / $448.51
| Professional | | $172.84 | $283.60 | $448.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.73 / $465.59 / $523.99
| Professional | | $260.73 | $465.59 | $523.99 |