- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $208.93 / $537.03
| Professional | | $173.78 | $208.93 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,862.09 / $45,708.82
| Facility | | $426.58 | $1,862.09 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $1,380.38
| Professional | | $173.78 | $295.12 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $501.19
| Professional | | $199.53 | $302.00 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $575.44 / $7,079.46
| Facility | | $169.82 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $323.59
| Professional | | $186.21 | $229.09 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $467.74
| Professional | | $173.78 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,862.09 / $45,708.82
| Facility | | $426.58 | $1,862.09 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $1,380.38
| Professional | | $173.78 | $295.12 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $537.03
| Professional | | $190.55 | $295.12 | $537.03 |