- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $741.31 / $1,412.54
| Professional | | $199.53 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,090.30
| Facility | | $1,318.26 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,148.15 / $1,479.11
| Professional | | $380.19 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $616.60 / $1,548.82
| Professional | | $239.88 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $741.31 / $2,398.83
| Facility | | $229.09 | $741.31 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $741.31 / $1,621.81
| Professional | | $281.84 | $741.31 | $1,621.81 |
- 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 / $2,630.27 / $3,715.35
| Facility | | $1,698.24 | $2,630.27 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $1,737.80
| Professional | | $323.59 | $549.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $691.83 / $2,398.83
| Professional | | $234.42 | $691.83 | $2,398.83 |
- 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
- $234.42 / $724.44 / $1,621.81
| Professional | | $234.42 | $724.44 | $1,621.81 |