- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $128.82 / $302.00
| Professional | | $107.15 | $128.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,623.41 / $14,791.08
| Facility | | $1,479.11 | $5,623.41 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $229.09
| Professional | | $186.21 | $218.78 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $245.47
| Professional | | $109.65 | $173.78 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $338.84
| Facility | | $112.20 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $199.53 / $234.42
| Professional | | $123.03 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,882.50 / $18,197.01
| Facility | | $9,772.37 | $12,882.50 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $245.47
| Professional | | $169.82 | $223.87 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $109.65 / $9,332.54
| Professional | | $100.00 | $109.65 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $251.19
| Professional | | $114.82 | $165.96 | $251.19 |