- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.44 / $7,119.04 / $19,276.96
| Facility | | $294.44 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $294.44 / $1,498.93
| Professional | | $261.33 | $294.44 | $1,498.93 |
- 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
- $276.62 / $464.63 / $628.66
| Professional | | $276.62 | $464.63 | $628.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.00 / $655.22 / $937.31
| Professional | | $467.00 | $655.22 | $937.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.00 / $485.83 / $1,329.76
| Facility | | $265.00 | $485.83 | $1,329.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.07 / $668.40 / $2,123.12
| Professional | | $394.07 | $668.40 | $2,123.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.54 / $745.81 / $1,508.92
| Facility | | $598.54 | $745.81 | $1,508.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.95 / $666.13 / $868.14
| Professional | | $549.95 | $666.13 | $868.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.16 / $526.85 / $652.48
| Professional | | $302.16 | $526.85 | $652.48 |
- 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
- $394.07 / $672.95 / $848.76
| Professional | | $394.07 | $672.95 | $848.76 |