- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,388.44 / $6,606.93
| Facility | | $1,148.15 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,548.82 / $7,244.36
| Professional | | $346.74 | $1,548.82 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $9,332.54
| Facility | | $56.23 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,174.90 / $4,265.80
| Professional | | $354.81 | $1,174.90 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $891.25
| Facility | | $380.19 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,778.28 / $3,801.89
| Professional | | $562.34 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,778.28 / $4,265.80
| Professional | | $489.78 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $467.74 / $7,079.46
| Facility | | $177.83 | $467.74 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $3,981.07
| Professional | | $1,737.80 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,445.44 / $3,715.35
| Professional | | $363.08 | $1,445.44 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,760.83 / $10,232.93
| Facility | | $4,570.88 | $6,760.83 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $676.08
| Professional | | $141.25 | $141.25 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $9,332.54
| Facility | | $56.23 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,174.90 / $4,265.80
| Professional | | $354.81 | $1,174.90 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $10,471.29
| Facility | | $2,137.96 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,698.24 / $4,168.69
| Professional | | $457.09 | $1,698.24 | $4,168.69 |