- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,818.38 / $5,128.61
| Facility | | $380.19 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $1,479.11
| Professional | | $281.84 | $446.68 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,011.87 / $28,840.32
| Facility | | $812.83 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $616.60 / $1,548.82
| Professional | | $316.23 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $891.25
| Facility | | $398.11 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $1,348.96
| Professional | | $398.11 | $676.08 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $691.83 / $7,079.46
| Facility | | $316.23 | $691.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,122.02
| Professional | | $616.60 | $794.33 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $691.83 / $1,479.11
| Professional | | $380.19 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,011.87 / $28,840.32
| Facility | | $812.83 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $616.60 / $1,584.89
| Professional | | $316.23 | $616.60 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,549.93
| Facility | | $1,862.09 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $1,318.26
| Professional | | $338.84 | $645.65 | $1,318.26 |