- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.80 / $1,060.18 / $1,502.32
| Facility | | $1,012.80 | $1,060.18 | $1,502.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.49 / $1,130.96 / $1,502.32
| Professional | | $795.49 | $1,130.96 | $1,502.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.83 / $282.10 / $569.40
| Facility | | $143.83 | $282.10 | $569.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.50 / $115.16 / $115.16
| Professional | | $99.50 | $115.16 | $115.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.70 / $1,791.70 / $1,791.70
| Facility | | $1,791.70 | $1,791.70 | $1,791.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,496.40
| Facility | | $1,122.47 | $1,122.47 | $1,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $954.10 / $1,459.20
| Professional | | $341.57 | $954.10 | $1,459.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,559.33 / $9,804.04 / $10,161.49
| Facility | | $3,559.33 | $9,804.04 | $10,161.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.91 / $764.55 / $1,693.13
| Facility | | $149.91 | $764.55 | $1,693.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.84 / $188.40 / $2,014.38
| Professional | | $164.84 | $188.40 | $2,014.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.80 / $764.55 / $1,502.32
| Facility | | $168.80 | $764.55 | $1,502.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.82 / $1,122.47 / $1,122.47
| Professional | | $140.82 | $1,122.47 | $1,122.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.05 / $852.22 / $1,540.24
| Professional | | $736.05 | $852.22 | $1,540.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.46 / $1,220.20 / $1,220.20
| Professional | | $1,152.46 | $1,220.20 | $1,220.20 |