- 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
- $169.82 / $257.04 / $676.08
| Professional | | $169.82 | $257.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,137.96 / $4,897.79
| Facility | | $1,071.52 | $2,137.96 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $398.11 / $1,023.29
| Professional | | $338.84 | $398.11 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $707.95
| Professional | | $190.55 | $295.12 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $398.11 / $1,023.29
| Facility | | $186.21 | $398.11 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $1,071.52
| Professional | | $199.53 | $354.81 | $1,071.52 |
- 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 / $3,890.45 / $6,025.60
| Facility | | $2,754.23 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $1,071.52
| Professional | | $302.00 | $371.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $512.86 / $3,019.95
| Professional | | $186.21 | $512.86 | $3,019.95 |
- 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
- $186.21 / $263.03 / $524.81
| Professional | | $186.21 | $263.03 | $524.81 |