- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.70 / $281.07 / $1,070.00
| Professional | | $227.70 | $281.07 | $1,070.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.63 / $227.63 / $227.63
| Professional | | $227.63 | $227.63 | $227.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,503.12 / $7,458.15 / $14,000.85
| Facility | | $5,503.12 | $7,458.15 | $14,000.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.09 / $373.44 / $497.94
| Professional | | $219.09 | $373.44 | $497.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.56 / $567.37 / $746.96
| Professional | | $456.56 | $567.37 | $746.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.95 / $533.70 / $6,451.00
| Facility | | $242.95 | $533.70 | $6,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.14 / $571.10 / $2,788.71
| Professional | | $327.14 | $571.10 | $2,788.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.56 / $627.41 / $3,054.91
| Facility | | $456.56 | $627.41 | $3,054.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.00 / $542.21 / $746.96
| Professional | | $409.00 | $542.21 | $746.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $443.30 / $618.70
| Professional | | $6.00 | $443.30 | $618.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.14 / $547.39 / $680.43
| Professional | | $327.14 | $547.39 | $680.43 |