- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $489.78 / $3,715.35
| Professional | | $177.83 | $489.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,943.28 / $35,481.34
| Facility | | $1,778.28 | $7,943.28 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $5,011.87 / $7,244.36
| Professional | | $724.44 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $630.96 / $4,168.69
| Professional | | $251.19 | $630.96 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $562.34 / $6,309.57
| Facility | | $229.09 | $562.34 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $9,772.37
| Professional | | $724.44 | $1,122.02 | $9,772.37 |
- 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
- $21,877.62 / $30,902.95 / $42,657.95
| Facility | | $21,877.62 | $30,902.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $2,137.96 / $7,079.46
| Professional | | $724.44 | $2,137.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $4,466.84 / $13,489.63
| Professional | | $389.05 | $4,466.84 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $11,748.98 / $165,958.69
| Facility | | $2,570.40 | $11,748.98 | $165,958.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $389.05 / $3,019.95
| Professional | | $204.17 | $389.05 | $3,019.95 |