- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.96 / $4,241.22 / $13,841.56
| Facility | | $1,400.96 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.63 / $110.84 / $745.01
| Professional | | $60.63 | $110.84 | $745.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.10 / $120.10 / $141.37
| Professional | | $120.10 | $120.10 | $141.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.80 / $2,223.57 / $3,902.23
| Facility | | $1,533.80 | $2,223.57 | $3,902.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.82 / $142.78 / $1,101.50
| Professional | | $62.82 | $142.78 | $1,101.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.30 / $721.78 / $1,896.50
| Professional | | $116.30 | $721.78 | $1,896.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.93 / $561.22 / $1,419.42
| Facility | | $62.93 | $561.22 | $1,419.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.74 / $1,419.89 / $4,312.47
| Professional | | $925.74 | $1,419.89 | $4,312.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.05 / $1,085.10 / $1,896.50
| Facility | | $157.05 | $1,085.10 | $1,896.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.19 / $1,112.74 / $1,696.23
| Professional | | $141.19 | $1,112.74 | $1,696.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $962.40 / $1,972.80
| Professional | | $4.00 | $962.40 | $1,972.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.44 / $1,366.49 / $1,728.05
| Professional | | $913.44 | $1,366.49 | $1,728.05 |