- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,995.26 / $3,715.35
| Facility | | $537.03 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $575.44 / $5,011.87
| Professional | | $501.19 | $575.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $2,238.72
| Facility | | $891.25 | $1,148.15 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,174.90 / $1,258.93
| Professional | | $602.56 | $1,174.90 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $1,819.70
| Professional | | $870.96 | $1,445.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $3,630.78
| Facility | | $457.09 | $954.99 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $1,513.56
| Professional | | $316.23 | $457.09 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $1,949.84
| Professional | | $1,548.82 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $1,412.54
| Facility | | $1,230.27 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $676.08 / $1,148.15
| Facility | | $338.84 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $457.09 / $831.76
| Professional | | $436.52 | $457.09 | $831.76 |