- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,818.38 / $5,128.61
| Facility | | $389.05 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $1,122.02
| Professional | | $354.81 | $446.68 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,398.83 / $28,840.32
| Facility | | $630.96 | $2,398.83 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,513.56
| Professional | | $354.81 | $602.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,122.02
| Facility | | $501.19 | $501.19 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $660.69 / $1,202.26
| Professional | | $389.05 | $660.69 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $891.25 / $7,079.46
| Facility | | $407.38 | $891.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $891.25
| Professional | | $562.34 | $691.83 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,288.25
| Professional | | $478.63 | $776.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,398.83 / $28,840.32
| Facility | | $691.83 | $2,398.83 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,513.56
| Professional | | $354.81 | $602.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $4,073.80
| Facility | | $630.96 | $2,041.74 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,288.25
| Professional | | $398.11 | $616.60 | $1,288.25 |