- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.70 / $4,182.08 / $13,841.56
| Facility | | $589.70 | $4,182.08 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.11 / $434.89 / $664.95
| Professional | | $206.11 | $434.89 | $664.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.58 / $308.23 / $308.23
| Professional | | $217.58 | $308.23 | $308.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,665.88 / $3,864.78 / $6,782.44
| Facility | | $2,665.88 | $3,864.78 | $6,782.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.11 / $737.36 / $986.62
| Professional | | $434.11 | $737.36 | $986.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.27 / $775.04 / $1,320.94
| Professional | | $340.27 | $775.04 | $1,320.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.56 / $604.48 / $1,467.76
| Facility | | $235.56 | $604.48 | $1,467.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.68 / $1,050.93 / $3,602.00
| Professional | | $666.68 | $1,050.93 | $3,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.13 / $953.00 / $1,373.94
| Facility | | $521.13 | $953.00 | $1,373.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.73 / $876.75 / $1,268.57
| Professional | | $492.73 | $876.75 | $1,268.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.61 / $565.20 / $1,118.25
| Professional | | $218.61 | $565.20 | $1,118.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.68 / $1,036.01 / $1,237.24
| Professional | | $666.68 | $1,036.01 | $1,237.24 |