- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,412.54 / $6,918.31
| Facility | | $204.17 | $1,412.54 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $588.84
| Professional | | $165.96 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,548.13 / $8,128.31
| Facility | | $1,584.89 | $3,548.13 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $537.03 / $660.69
| Professional | | $275.42 | $537.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $616.60
| Professional | | $181.97 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $380.19 / $2,238.72
| Facility | | $204.17 | $380.19 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $309.03 / $660.69
| Professional | | $173.78 | $309.03 | $660.69 |
- 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
- $204.17 / $288.40 / $602.56
| Professional | | $204.17 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $316.23 / $5,754.40
| Professional | | $288.40 | $316.23 | $5,754.40 |
- 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
- $186.21 / $316.23 / $562.34
| Professional | | $186.21 | $316.23 | $562.34 |