- 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
- $154.88 / $257.04 / $457.09
| Professional | | $154.88 | $257.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,412.54 / $4,265.80
| Facility | | $295.12 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $501.19
| Professional | | $275.42 | $338.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $426.58
| Professional | | $181.97 | $281.84 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $630.96
| Facility | | $190.55 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $524.81
| Professional | | $257.04 | $426.58 | $524.81 |
- 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
- $2,754.23 / $3,630.78 / $5,248.07
| Facility | | $2,754.23 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $524.81
| Professional | | $218.78 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $1,995.26
| Professional | | $186.21 | $295.12 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,630.27 / $4,466.84
| Facility | | $446.68 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $457.09
| Professional | | $177.83 | $288.40 | $457.09 |