- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $6,760.83
| Facility | | $1,778.28 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,584.89
| Professional | | $331.13 | $467.74 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,495.41 / $45,708.82
| Facility | | $891.25 | $5,495.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $2,630.27
| Professional | | $281.84 | $562.34 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $954.99
| Professional | | $489.78 | $724.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,348.96
| Professional | | $501.19 | $776.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $741.31 / $7,079.46
| Facility | | $346.74 | $741.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $489.78 / $831.76
| Professional | | $407.38 | $489.78 | $831.76 |
- 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
- $354.81 / $630.96 / $1,148.15
| Professional | | $354.81 | $630.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,630.78 / $9,332.54
| Facility | | $3,090.30 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,495.41 / $45,708.82
| Facility | | $891.25 | $5,495.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $2,630.27
| Professional | | $281.84 | $562.34 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,471.29
| Facility | | $2,041.74 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $1,513.56
| Professional | | $416.87 | $630.96 | $1,513.56 |