- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,890.45 / $5,495.41
| Facility | | $977.24 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $512.86
| Professional | | $204.17 | $309.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,235.94 / $5,248.07
| Facility | | $1,584.89 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $416.87 / $512.86
| Professional | | $371.54 | $416.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $457.09
| Professional | | $239.88 | $346.74 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $457.09 / $3,890.45
| Facility | | $229.09 | $457.09 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $524.81
| Professional | | $223.87 | $389.05 | $524.81 |
- 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
- $3,630.78 / $4,677.35 / $6,456.54
| Facility | | $3,630.78 | $4,677.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $416.87
| Professional | | $269.15 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $4,786.30
| Professional | | $245.47 | $363.08 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $489.78
| Professional | | $218.78 | $331.13 | $489.78 |