- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,548.13 / $8,317.64
| Facility | | $478.63 | $3,548.13 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $724.44
| Professional | | $295.12 | $398.11 | $724.44 |
- 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
- $354.81 / $524.81 / $758.58
| Professional | | $354.81 | $524.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $2,570.40 / $3,548.13
| Professional | | $346.74 | $2,570.40 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,862.09
| Facility | | $575.44 | $575.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $812.83
| Professional | | $338.84 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $676.08
| Professional | | $426.58 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $630.96
| Professional | | $549.54 | $549.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $707.95
| Facility | | $316.23 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $4,073.80
| Facility | | $302.00 | $457.09 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $4,073.80
| Professional | | $398.11 | $602.56 | $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
- $281.84 / $436.52 / $758.58
| Professional | | $281.84 | $436.52 | $758.58 |