- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.06 / $6,732.07 / $19,276.96
| Facility | | $399.06 | $6,732.07 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.23 / $399.06 / $973.04
| Professional | | $275.23 | $399.06 | $973.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.43 / $406.43 / $406.43
| Professional | | $406.43 | $406.43 | $406.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.19 / $543.04 / $814.47
| Professional | | $294.19 | $543.04 | $814.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.47 / $847.74 / $1,236.82
| Professional | | $521.47 | $847.74 | $1,236.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.29 / $524.84 / $1,399.04
| Facility | | $327.29 | $524.84 | $1,399.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.23 / $896.57 / $2,235.28
| Professional | | $540.23 | $896.57 | $2,235.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.02 / $931.59 / $2,842.49
| Facility | | $655.02 | $931.59 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.12 / $802.33 / $1,144.54
| Professional | | $597.12 | $802.33 | $1,144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.23 / $906.56 / $1,163.57
| Professional | | $540.23 | $906.56 | $1,163.57 |