- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.17 / $1,297.60 / $16,733.00
| Facility | | $497.17 | $1,297.60 | $16,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.68 / $479.62 / $497.17
| Professional | | $438.68 | $479.62 | $497.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.44 / $2,848.46 / $3,597.14
| Facility | | $2,221.44 | $2,848.46 | $3,597.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.83 / $288.83 / $461.59
| Professional | | $288.83 | $288.83 | $461.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.92 / $538.11 / $1,049.31
| Professional | | $467.92 | $538.11 | $1,049.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,289.09 / $2,995.90
| Facility | | $380.19 | $1,289.09 | $2,995.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.27 / $712.27 / $853.38
| Professional | | $712.27 | $712.27 | $853.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $701.88 / $865.65
| Professional | | $584.90 | $701.88 | $865.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.00 / $584.90 / $994.34
| Facility | | $465.00 | $584.90 | $994.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.00 / $1,023.58 / $1,403.76
| Professional | | $801.00 | $1,023.58 | $1,403.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.43 / $672.63 / $1,082.07
| Facility | | $409.43 | $672.63 | $1,082.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.43 / $665.03 / $1,085.93
| Professional | | $409.43 | $665.03 | $1,085.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.88 / $701.88 / $701.88
| Facility | | $701.88 | $701.88 | $701.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $292.45 / $672.64
| Professional | | $245.66 | $292.45 | $672.64 |