- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $912.01
| Professional | | $389.05 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $1,819.70 / $4,168.69
| Facility | | $104.71 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $912.01
| Professional | | $758.58 | $891.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $776.25
| Professional | | $436.52 | $602.56 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $1,318.26
| Facility | | $436.52 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $1,096.48
| Professional | | $707.95 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,011.87
| Facility | | $2,691.53 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $977.24
| Professional | | $616.60 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $2,511.89
| Professional | | $407.38 | $524.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $891.25
| Professional | | $426.58 | $645.65 | $891.25 |