- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $5,623.41
| Facility | | $1,778.28 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $2,089.30
| Professional | | $371.54 | $524.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,128.61 / $45,708.82
| Facility | | $912.01 | $5,128.61 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $616.60 / $4,897.79
| Professional | | $295.12 | $616.60 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $1,348.96
| Professional | | $426.58 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $724.44 / $7,079.46
| Facility | | $346.74 | $724.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $398.11 / $602.56
| Professional | | $204.17 | $398.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,071.52
| Professional | | $380.19 | $676.08 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,709.64 / $12,882.50
| Facility | | $3,715.35 | $8,709.64 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $676.08 / $912.01
| Professional | | $645.65 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,370.32 / $45,708.82
| Facility | | $912.01 | $5,370.32 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $616.60 / $4,897.79
| Professional | | $295.12 | $616.60 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $1,412.54
| Professional | | $426.58 | $724.44 | $1,412.54 |