- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,818.38 / $6,025.60
| Facility | | $575.44 | $2,818.38 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,479.11
| Professional | | $323.59 | $489.78 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $4,168.69
| Facility | | $1,621.81 | $2,691.53 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $707.95
| Professional | | $575.44 | $691.83 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $602.56
| Professional | | $338.84 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $660.69 / $2,818.38
| Facility | | $346.74 | $660.69 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $851.14
| Professional | | $457.09 | $630.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,890.45 / $5,011.87
| Facility | | $2,884.03 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $758.58
| Professional | | $478.63 | $676.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $602.56 / $1,737.80
| Professional | | $309.03 | $602.56 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $12,302.69
| Facility | | $1,348.96 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $691.83
| Professional | | $354.81 | $501.19 | $691.83 |