- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $524.81
| Professional | | $114.82 | $141.25 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $28,840.32
| Facility | | $309.03 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $194.98 / $1,071.52
| Professional | | $107.15 | $194.98 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $407.38
| Professional | | $213.80 | $389.05 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $239.88 / $446.68
| Professional | | $125.89 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $501.19 / $7,079.46
| Facility | | $117.49 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $131.83 / $194.98
| Professional | | $69.18 | $131.83 | $194.98 |
- 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
- $138.04 / $223.87 / $363.08
| Professional | | $138.04 | $223.87 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $28,840.32
| Facility | | $309.03 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $194.98 / $1,071.52
| Professional | | $107.15 | $194.98 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $501.19
| Professional | | $141.25 | $208.93 | $501.19 |