- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,248.07
| Facility | | $1,513.56 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $912.01 / $2,398.83
| Professional | | $199.53 | $912.01 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,818.38 / $9,549.93
| Facility | | $56.23 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $977.24 / $3,311.31
| Professional | | $213.80 | $977.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $524.81
| Facility | | $223.87 | $223.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,174.90 / $2,511.89
| Professional | | $316.23 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,905.46 / $3,715.35
| Facility | | $676.08 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $724.44 / $2,951.21
| Professional | | $239.88 | $724.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $7,079.46
| Facility | | $173.78 | $288.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $3,090.30
| Professional | | $1,023.29 | $1,513.56 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,570.88 / $11,220.18
| Facility | | $645.65 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $954.99 / $2,454.71
| Professional | | $208.93 | $954.99 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,818.38 / $7,413.10
| Facility | | $1,819.70 | $2,818.38 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,818.38 / $9,549.93
| Facility | | $56.23 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $977.24 / $3,311.31
| Professional | | $213.80 | $977.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,786.30 / $10,232.93
| Facility | | $1,659.59 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $812.83 / $2,630.27
| Professional | | $218.78 | $812.83 | $2,630.27 |