- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,090.30 / $5,128.61
| Facility | | $1,479.11 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $489.78
| Professional | | $165.96 | $194.98 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,897.79 / $12,882.50
| Facility | | $56.23 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $288.40 / $676.08
| Professional | | $162.18 | $288.40 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $363.08 / $363.08
| Professional | | $316.23 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $398.11 / $707.95
| Professional | | $239.88 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $380.19 / $7,079.46
| Facility | | $162.18 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $398.11
| Professional | | $181.97 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $501.19
| Professional | | $190.55 | $309.03 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,897.79 / $12,882.50
| Facility | | $56.23 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $288.40 / $676.08
| Professional | | $162.18 | $288.40 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $602.56
| Professional | | $223.87 | $323.59 | $602.56 |