- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.67 / $888.03 / $6,953.60
| Facility | | $258.67 | $888.03 | $6,953.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.67 / $516.21 / $921.86
| Professional | | $258.67 | $516.21 | $921.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.07 / $228.83 / $394.38
| Professional | | $227.07 | $228.83 | $394.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.55 / $1,703.55 / $1,728.40
| Facility | | $1,703.55 | $1,703.55 | $1,728.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.32 / $957.78 / $1,766.79
| Professional | | $457.32 | $957.78 | $1,766.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.10 / $792.30 / $1,520.87
| Professional | | $407.10 | $792.30 | $1,520.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.43 / $715.95 / $1,124.09
| Facility | | $266.43 | $715.95 | $1,124.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.00 / $879.00 / $879.00
| Professional | | $480.00 | $879.00 | $879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $484.90 / $1,881.40
| Professional | | $3.00 | $484.90 | $1,881.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.63 / $809.35 / $1,471.09
| Professional | | $582.63 | $809.35 | $1,471.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.45 / $1,476.72 / $26,542.00
| Facility | | $1,387.45 | $1,476.72 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,742.05 / $3,433.90 / $4,711.68
| Professional | | $2,742.05 | $3,433.90 | $4,711.68 |