- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $323.59 / $478.63
| Professional | | $204.17 | $323.59 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,884.03 / $4,786.30
| Facility | | $1,348.96 | $2,884.03 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $446.68 / $549.54
| Professional | | $389.05 | $446.68 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $467.74
| Professional | | $239.88 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $1,096.48
| Facility | | $245.47 | $398.11 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $549.54
| Professional | | $213.80 | $380.19 | $549.54 |
- 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
- $3,311.31 / $4,073.80 / $6,025.60
| Facility | | $3,311.31 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $389.05 / $457.09
| Professional | | $295.12 | $389.05 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $3,981.07
| Professional | | $251.19 | $363.08 | $3,981.07 |
- 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
- $208.93 / $302.00 / $446.68
| Professional | | $208.93 | $302.00 | $446.68 |