- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,137.96 / $7,244.36
| Facility | | $229.09 | $2,137.96 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $588.84
| Professional | | $165.96 | $251.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $436.52
| Professional | | $190.55 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $2,570.40 / $3,548.13
| Professional | | $173.78 | $2,570.40 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $1,659.59
| Facility | | $309.03 | $309.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $467.74
| Professional | | $190.55 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $389.05
| Professional | | $251.19 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $398.11
| Professional | | $331.13 | $331.13 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $398.11
| Facility | | $173.78 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $4,073.80
| Facility | | $173.78 | $251.19 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $4,073.80
| Professional | | $234.42 | $354.81 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $436.52
| Professional | | $158.49 | $251.19 | $436.52 |