- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,570.40 / $7,079.46
| Facility | | $363.08 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $660.69
| Professional | | $275.42 | $338.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $758.58
| Professional | | $302.00 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $2,511.89
| Professional | | $309.03 | $446.68 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $707.95
| Professional | | $288.40 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $562.34
| Professional | | $371.54 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $776.25
| Professional | | $371.54 | $467.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $616.60
| Facility | | $288.40 | $389.05 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $1,380.38
| Facility | | $263.03 | $371.54 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $1,479.11
| Professional | | $295.12 | $407.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,148.15 / $2,398.83
| Facility | | $218.78 | $1,148.15 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $616.60
| Professional | | $223.87 | $346.74 | $616.60 |