- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,388.44 / $6,165.95
| Facility | | $1,819.70 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $1,288.25 / $5,623.41
| Professional | | $245.47 | $1,288.25 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $6,165.95 / $50,118.72
| Facility | | $588.84 | $6,165.95 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,698.24 / $6,456.54
| Professional | | $263.03 | $1,698.24 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $660.69
| Facility | | $281.84 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $6,760.83
| Professional | | $478.63 | $758.58 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,122.02 / $5,888.44
| Professional | | $316.23 | $1,122.02 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $501.19 / $7,079.46
| Facility | | $218.78 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $3,630.78
| Professional | | $1,288.25 | $2,398.83 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $2,041.74 / $5,248.07
| Professional | | $263.03 | $2,041.74 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,370.32 / $14,125.38
| Facility | | $4,365.16 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $6,309.57 / $50,118.72
| Facility | | $588.84 | $6,309.57 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,698.24 / $6,309.57
| Professional | | $263.03 | $1,698.24 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $12,022.64
| Facility | | $2,137.96 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,023.29 / $5,248.07
| Professional | | $331.13 | $1,023.29 | $5,248.07 |