- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,754.23 / $4,897.79
| Facility | | $1,202.26 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $1,479.11 / $3,090.30
| Professional | | $120.23 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $5,623.41
| Facility | | $56.23 | $2,398.83 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $1,047.13 / $3,801.89
| Professional | | $123.03 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $309.03
| Facility | | $131.83 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $776.25 / $3,311.31
| Professional | | $194.98 | $776.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $602.56 / $3,981.07
| Professional | | $181.97 | $602.56 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $7,079.46
| Facility | | $104.71 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,995.26 / $3,630.78
| Professional | | $1,621.81 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $1,318.26 / $3,388.44
| Professional | | $128.82 | $1,318.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $5,623.41
| Facility | | $56.23 | $2,398.83 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $1,047.13 / $3,801.89
| Professional | | $123.03 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,630.78 / $8,511.38
| Facility | | $1,621.81 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $1,548.82 / $3,801.89
| Professional | | $144.54 | $1,548.82 | $3,801.89 |