- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $741.31
| Professional | | $117.49 | $204.17 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,370.32 / $25,703.96
| Facility | | $56.23 | $5,370.32 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $263.03 / $3,311.31
| Professional | | $125.89 | $263.03 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $602.56
| Professional | | $208.93 | $346.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $302.00 / $8,511.38
| Facility | | $144.54 | $302.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $389.05
| Professional | | $165.96 | $204.17 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $269.15 / $524.81
| Professional | | $147.91 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,888.44 / $25,703.96
| Facility | | $56.23 | $5,888.44 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $263.03 / $3,311.31
| Professional | | $125.89 | $263.03 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $676.08
| Professional | | $186.21 | $295.12 | $676.08 |