- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.16 / $739.12 / $2,031.80
| Facility | | $212.16 | $739.12 | $2,031.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.16 / $234.79 / $240.45
| Professional | | $154.16 | $234.79 | $240.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $1,417.23
| Facility | | $244.00 | $614.00 | $1,417.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.83 / $672.63 / $1,099.60
| Professional | | $288.83 | $672.63 | $1,099.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.71 / $183.87 / $459.77
| Professional | | $128.71 | $183.87 | $459.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.63 / $398.26 / $925.79
| Facility | | $186.63 | $398.26 | $925.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,599.84 / $1,640.24 / $1,807.50
| Professional | | $1,599.84 | $1,640.24 | $1,807.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $325.31 / $381.89
| Professional | | $282.88 | $325.31 | $381.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.59 / $325.31 / $540.29
| Professional | | $254.59 | $325.31 | $540.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.21 / $1,343.68 / $1,343.68
| Facility | | $492.21 | $1,343.68 | $1,343.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.74 / $1,408.74 / $2,121.60
| Professional | | $1,408.74 | $1,408.74 | $2,121.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.84 / $339.46 / $750.56
| Facility | | $229.84 | $339.46 | $750.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $311.17 / $1,637.82
| Professional | | $282.88 | $311.17 | $1,637.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.30 / $288.54 / $480.90
| Professional | | $226.30 | $288.54 | $480.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $118.81 / $681.15
| Professional | | $118.81 | $118.81 | $681.15 |