- 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
- $501.19 / $758.58 / $1,513.56
| Professional | | $501.19 | $758.58 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,318.26 / $6,025.60
| Facility | | $489.78 | $1,318.26 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $1,380.38
| Professional | | $794.33 | $1,023.29 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $1,202.26
| Professional | | $389.05 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,698.24
| Facility | | $398.11 | $758.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $1,412.54
| Professional | | $537.03 | $891.25 | $1,412.54 |
- 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
- $4,073.80 / $5,248.07 / $7,585.78
| Facility | | $4,073.80 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,445.44
| Professional | | $707.95 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $3,630.78
| Professional | | $457.09 | $794.33 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,467.37 / $7,762.47
| Facility | | $501.19 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,288.25
| Professional | | $537.03 | $812.83 | $1,288.25 |