- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.56 / $3,795.64 / $13,841.56
| Facility | | $1,087.56 | $3,795.64 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.71 / $262.47 / $1,139.00
| Professional | | $207.71 | $262.47 | $1,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.27 / $323.27 / $323.27
| Professional | | $323.27 | $323.27 | $323.27 |
- 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
- $220.52 / $377.98 / $526.25
| Professional | | $220.52 | $377.98 | $526.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.89 / $623.72 / $808.92
| Professional | | $234.89 | $623.72 | $808.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.52 / $468.47 / $2,398.48
| Facility | | $261.52 | $468.47 | $2,398.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.38 / $589.14 / $2,111.84
| Professional | | $334.38 | $589.14 | $2,111.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.46 / $646.00 / $1,311.70
| Facility | | $501.46 | $646.00 | $1,311.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.80 / $554.03 / $751.61
| Professional | | $422.80 | $554.03 | $751.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.00 / $371.20 / $569.80
| Professional | | $238.00 | $371.20 | $569.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.38 / $589.14 / $664.05
| Professional | | $334.38 | $589.14 | $664.05 |