- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,630.78 / $8,317.64
| Facility | | $537.03 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $416.87 / $794.33
| Professional | | $147.91 | $416.87 | $794.33 |
- 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
- $169.82 / $426.58 / $794.33
| Professional | | $169.82 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $302.00 / $3,548.13
| Professional | | $194.98 | $302.00 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $457.09 / $1,071.52
| Professional | | $181.97 | $457.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $588.84 / $1,513.56
| Professional | | $134.90 | $588.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $446.68 / $954.99
| Facility | | $158.49 | $446.68 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $4,073.80
| Facility | | $158.49 | $234.42 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $870.96 / $4,073.80
| Professional | | $562.34 | $870.96 | $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
- $154.88 / $407.38 / $1,148.15
| Professional | | $154.88 | $407.38 | $1,148.15 |