- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,819.70 / $10,471.29
| Facility | | $398.11 | $1,819.70 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $1,148.15
| Professional | | $371.54 | $478.63 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $1,096.48
| Professional | | $426.58 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,737.80 / $3,235.94
| Facility | | $501.19 | $1,737.80 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $954.99
| Professional | | $416.87 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $501.19 / $812.83
| Facility | | $389.05 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $933.25
| Professional | | $478.63 | $630.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $14,125.38
| Facility | | $1,148.15 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $794.33
| Professional | | $331.13 | $436.52 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $33,884.42
| Facility | | $9,549.93 | $9,549.93 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,677.35 / $4,677.35
| Professional | | $3,548.13 | $4,677.35 | $4,677.35 |