- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,897.79 / $8,511.38
| Facility | | $1,122.02 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $363.08
| Professional | | $144.54 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $10,000.00
| Facility | | $2,238.72 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $181.97 / $316.23
| Professional | | $147.91 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $158.49 / $234.42
| Professional | | $134.90 | $158.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $426.58
| Professional | | $151.36 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $724.44 / $9,772.37
| Facility | | $54.95 | $724.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $1,148.15
| Professional | | $151.36 | $257.04 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,818.38 / $10,471.29
| Facility | | $1,288.25 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $407.38
| Professional | | $154.88 | $239.88 | $407.38 |