- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,981.07 / $7,943.28
| Facility | | $512.86 | $3,981.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $1,445.44
| Professional | | $316.23 | $478.63 | $1,445.44 |
- 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
- $338.84 / $512.86 / $870.96
| Professional | | $338.84 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $3,548.13
| Professional | | $389.05 | $562.34 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $741.31
| Professional | | $338.84 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $501.19
| Professional | | $331.13 | $426.58 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $794.33
| Professional | | $512.86 | $645.65 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $707.95
| Facility | | $331.13 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $6,918.31
| Facility | | $331.13 | $457.09 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $6,918.31
| Professional | | $331.13 | $457.09 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $691.83
| Professional | | $263.03 | $416.87 | $691.83 |