- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $10,232.93
| Facility | | $1,659.59 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $1,288.25
| Professional | | $251.19 | $316.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $257.04
| Professional | | $234.42 | $234.42 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $8,128.31
| Facility | | $4,570.88 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $524.81
| Professional | | $239.88 | $323.59 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,168.69 / $4,265.80
| Facility | | $3,090.30 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $501.19
| Professional | | $234.42 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $288.40 / $3,890.45
| Professional | | $4.68 | $288.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $4,786.30
| Professional | | $363.08 | $363.08 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $524.81
| Professional | | $239.88 | $239.88 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $7,244.36
| Facility | | $891.25 | $2,187.76 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $478.63
| Professional | | $229.09 | $288.40 | $478.63 |