- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,621.81 / $5,495.41
| Facility | | $346.74 | $1,621.81 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $630.96 / $1,479.11
| Professional | | $204.17 | $630.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,187.76 / $5,011.87
| Facility | | $891.25 | $2,187.76 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,202.26 / $1,584.89
| Professional | | $371.54 | $1,202.26 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $630.96 / $1,621.81
| Professional | | $245.47 | $630.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $776.25 / $2,570.40
| Facility | | $234.42 | $776.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $758.58 / $1,737.80
| Professional | | $251.19 | $758.58 | $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
- $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
- $316.23 / $537.03 / $1,862.09
| Professional | | $316.23 | $537.03 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $724.44 / $2,884.03
| Professional | | $229.09 | $724.44 | $2,884.03 |
- 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
- $239.88 / $776.25 / $1,778.28
| Professional | | $239.88 | $776.25 | $1,778.28 |