- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,801.89 / $8,317.64
| Facility | | $831.76 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $758.58
| Professional | | $151.36 | $245.47 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $257.04 / $416.87
| Professional | | $165.96 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $457.09
| Professional | | $120.23 | $229.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $467.74
| Professional | | $213.80 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,698.24 / $3,235.94
| Facility | | $954.99 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $269.15 / $302.00
| Professional | | $251.19 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,090.30 / $8,317.64
| Facility | | $758.58 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $602.56
| Professional | | $158.49 | $263.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $407.38
| Facility | | $114.82 | $186.21 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $234.42 / $407.38
| Professional | | $123.03 | $234.42 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,584.89 / $3,890.45
| Facility | | $467.74 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $416.87
| Professional | | $158.49 | $239.88 | $416.87 |