- 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
- $239.88 / $588.84 / $4,466.84
| Professional | | $239.88 | $588.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,698.24 / $3,090.30
| Facility | | $691.83 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $3,311.31 / $4,365.16
| Professional | | $436.52 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $4,786.30
| Professional | | $295.12 | $562.34 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $776.25 / $7,079.46
| Facility | | $263.03 | $776.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $660.69 / $5,128.61
| Professional | | $331.13 | $660.69 | $5,128.61 |
- 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
- $1,698.24 / $2,398.83 / $3,715.35
| Facility | | $1,698.24 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $5,888.44
| Professional | | $380.19 | $645.65 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $2,398.83 / $4,466.84
| Professional | | $239.88 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $575.44 / $4,466.84
| Professional | | $275.42 | $575.44 | $4,466.84 |