- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,344.23 / $5,495.41
| Facility | | $1,047.13 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $616.60 / $1,258.93
| Professional | | $263.03 | $616.60 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,548.82 / $3,090.30
| Facility | | $645.65 | $1,548.82 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $977.24 / $1,288.25
| Professional | | $467.74 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $1,230.27
| Professional | | $316.23 | $549.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $776.25 / $1,698.24
| Facility | | $331.13 | $776.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $676.08 / $1,445.44
| Professional | | $316.23 | $676.08 | $1,445.44 |
- 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
- $407.38 / $691.83 / $1,380.38
| Professional | | $407.38 | $691.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $676.08 / $2,041.74
| Professional | | $288.40 | $676.08 | $2,041.74 |
- 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
- $316.23 / $645.65 / $1,202.26
| Professional | | $316.23 | $645.65 | $1,202.26 |