- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.17 / $2,047.15 / $2,446.19
| Facility | | $497.17 | $2,047.15 | $2,446.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $473.77 / $497.17
| Professional | | $350.94 | $473.77 | $497.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.22 / $456.22 / $456.22
| Professional | | $456.22 | $456.22 | $456.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.60 / $759.92 / $1,747.73
| Facility | | $391.60 | $759.92 | $1,747.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,819.22 / $2,819.22 / $2,819.22
| Professional | | $2,819.22 | $2,819.22 | $2,819.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.15 / $789.62 / $1,444.70
| Professional | | $614.15 | $789.62 | $1,444.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.29 / $2,018.26 / $2,446.19
| Facility | | $651.29 | $2,018.26 | $2,446.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.87 / $497.17 / $2,415.64
| Professional | | $383.87 | $497.17 | $2,415.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.65 / $877.35 / $1,169.80
| Professional | | $865.65 | $877.35 | $1,169.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.56 / $738.98 / $1,940.67
| Facility | | $407.56 | $738.98 | $1,940.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,819.22 / $2,819.22 / $2,819.22
| Professional | | $2,819.22 | $2,819.22 | $2,819.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $643.39
| Facility | | $584.90 | $584.90 | $643.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $643.39
| Professional | | $584.90 | $584.90 | $643.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $350.94 / $877.35
| Professional | | $245.66 | $350.94 | $877.35 |