- 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
- $177.83 / $251.19 / $407.38
| Professional | | $177.83 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,548.13 / $9,332.54
| Facility | | $1,479.11 | $3,548.13 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $446.68
| Professional | | $316.23 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $389.05
| Professional | | $186.21 | $288.40 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $1,096.48
| Facility | | $199.53 | $323.59 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $446.68
| Professional | | $181.97 | $309.03 | $446.68 |
- 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
- $5,128.61 / $7,079.46 / $9,772.37
| Facility | | $5,128.61 | $7,079.46 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $380.19
| Professional | | $239.88 | $323.59 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $6,025.60
| Professional | | $204.17 | $288.40 | $6,025.60 |
- 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
- $169.82 / $245.47 / $363.08
| Professional | | $169.82 | $245.47 | $363.08 |