- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.30 / $1,157.94 / $2,226.81
| Facility | | $661.30 | $1,157.94 | $2,226.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.59 / $601.24 / $645.77
| Professional | | $519.59 | $601.24 | $645.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $536.66 / $2,093.19
| Facility | | $92.60 | $536.66 | $2,093.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $1,356.87 / $2,894.85
| Facility | | $800.00 | $1,356.87 | $2,894.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.11 / $742.27 / $3,637.12
| Facility | | $80.11 | $742.27 | $3,637.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.45 / $1,039.17 / $1,313.81
| Facility | | $868.45 | $1,039.17 | $1,313.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $1,128.25
| Professional | | $742.27 | $742.27 | $1,128.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $742.27
| Professional | | $742.27 | $742.27 | $742.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.35 / $699.20 / $1,163.52
| Professional | | $567.35 | $699.20 | $1,163.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.36 / $445.36 / $630.92
| Professional | | $445.36 | $445.36 | $630.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.74 / $482.48 / $1,212.91
| Professional | | $337.74 | $482.48 | $1,212.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.10 / $1,254.45 / $2,226.65
| Facility | | $603.10 | $1,254.45 | $2,226.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.79 / $904.45 / $1,083.64
| Professional | | $861.79 | $904.45 | $1,083.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.15 / $742.27 / $1,002.06
| Facility | | $705.15 | $742.27 | $1,002.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $853.61
| Professional | | $311.75 | $445.36 | $853.61 |