- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.71 / $8,042.03 / $19,276.96
| Facility | | $429.71 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.89 / $429.71 / $1,203.15
| Professional | | $224.89 | $429.71 | $1,203.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.59 / $408.59 / $408.59
| Professional | | $408.59 | $408.59 | $408.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,063.17 / $11,728.12
| Facility | | $4,609.82 | $6,063.17 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.22 / $460.19 / $868.32
| Professional | | $238.22 | $460.19 | $868.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $1,802.85 / $1,802.85
| Facility | | $1,802.85 | $1,802.85 | $1,802.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.02 / $855.39 / $1,341.03
| Professional | | $453.02 | $855.39 | $1,341.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.54 / $495.32 / $1,157.32
| Facility | | $269.54 | $495.32 | $1,157.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.73 / $959.97 / $1,825.92
| Professional | | $576.73 | $959.97 | $1,825.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.11 / $1,017.45 / $2,163.42
| Facility | | $553.11 | $1,017.45 | $2,163.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.22 / $838.00 / $1,259.08
| Professional | | $550.22 | $838.00 | $1,259.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,483.00 / $7,934.00
| Facility | | $3,711.00 | $5,483.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.73 / $953.83 / $1,242.19
| Professional | | $576.73 | $953.83 | $1,242.19 |