- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,041.74 / $7,943.28
| Facility | | $416.87 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $933.25
| Professional | | $281.84 | $446.68 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $812.83
| Professional | | $346.74 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,737.80 / $2,754.23
| Professional | | $331.13 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,862.09
| Facility | | $562.34 | $562.34 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $891.25
| Professional | | $346.74 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $691.83
| Professional | | $446.68 | $588.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $776.25
| Professional | | $676.08 | $676.08 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $794.33
| Facility | | $316.23 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $4,073.80
| Facility | | $323.59 | $501.19 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $4,073.80
| Professional | | $467.74 | $676.08 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,230.27 / $2,511.89
| Facility | | $229.09 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $812.83
| Professional | | $316.23 | $489.78 | $812.83 |