- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $13,182.57
| Facility | | $1,047.13 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $501.19 / $891.25
| Professional | | $389.05 | $501.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $13,489.63
| Facility | | $1,819.70 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $776.25
| Professional | | $645.65 | $758.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $741.31
| Professional | | $467.74 | $616.60 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $891.25 / $4,786.30
| Facility | | $489.78 | $891.25 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $776.25
| Professional | | $389.05 | $602.56 | $776.25 |
- 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
- $8,511.38 / $11,748.98 / $16,218.10
| Facility | | $8,511.38 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $741.31
| Professional | | $524.81 | $616.60 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $5,623.41
| Professional | | $323.59 | $676.08 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $870.96
| Professional | | $426.58 | $660.69 | $870.96 |