- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,570.40 / $5,495.41
| Facility | | $812.83 | $2,570.40 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $512.86 / $1,348.96
| Professional | | $229.09 | $512.86 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,621.81 / $3,090.30
| Facility | | $891.25 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,174.90 / $1,548.82
| Professional | | $426.58 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $645.65 / $1,513.56
| Professional | | $281.84 | $645.65 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $812.83 / $2,570.40
| Facility | | $269.15 | $812.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $616.60 / $1,737.80
| Professional | | $302.00 | $616.60 | $1,737.80 |
- 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
- $371.54 / $630.96 / $1,659.59
| Professional | | $371.54 | $630.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $831.76 / $1,584.89
| Professional | | $234.42 | $831.76 | $1,584.89 |
- 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
- $269.15 / $660.69 / $1,380.38
| Professional | | $269.15 | $660.69 | $1,380.38 |