- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,467.37 / $7,244.36
| Facility | | $489.78 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $1,023.29
| Professional | | $354.81 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $758.58
| Professional | | $363.08 | $537.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $2,290.87 / $3,548.13
| Professional | | $363.08 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $831.76
| Professional | | $354.81 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $512.86 / $660.69
| Professional | | $331.13 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $676.08
| Professional | | $537.03 | $616.60 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $794.33
| Facility | | $363.08 | $524.81 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $4,073.80
| Facility | | $338.84 | $501.19 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $4,073.80
| Professional | | $407.38 | $575.44 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,467.37 / $5,754.40
| Facility | | $1,819.70 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $741.31
| Professional | | $295.12 | $407.38 | $741.31 |