- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.70 / $1,939.42 / $5,331.36
| Facility | | $556.70 | $1,939.42 | $5,331.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.54 / $616.08 / $630.92
| Professional | | $404.54 | $616.08 | $630.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.00 / $736.40 / $3,718.77
| Facility | | $260.00 | $736.40 | $3,718.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.20 / $832.04 / $1,699.05
| Professional | | $699.20 | $832.04 | $1,699.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $979.80 / $6,658.16
| Facility | | $59.40 | $979.80 | $6,658.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.74 / $482.48 / $1,206.44
| Professional | | $337.74 | $482.48 | $1,206.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.72 / $955.31 / $1,876.85
| Facility | | $489.72 | $955.31 | $1,876.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $816.50 / $1,002.06
| Professional | | $742.27 | $816.50 | $1,002.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.04 / $853.61 / $1,618.15
| Professional | | $668.04 | $853.61 | $1,618.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.55 / $3,525.78 / $3,525.78
| Facility | | $1,291.55 | $3,525.78 | $3,525.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,696.50 / $3,696.50 / $5,567.03
| Professional | | $3,696.50 | $3,696.50 | $5,567.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.82 / $890.72 / $1,656.40
| Facility | | $593.82 | $890.72 | $1,656.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $816.50 / $1,113.41
| Professional | | $742.27 | $816.50 | $1,113.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $334.02 / $1,474.74
| Professional | | $311.75 | $334.02 | $1,474.74 |