- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,168.69 / $8,317.64
| Facility | | $323.59 | $4,168.69 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $645.65
| Professional | | $263.03 | $323.59 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $691.83
| Professional | | $275.42 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $2,511.89
| Professional | | $302.00 | $436.52 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $660.69
| Professional | | $288.40 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $467.74
| Professional | | $316.23 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $724.44
| Professional | | $407.38 | $512.86 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $616.60
| Facility | | $275.42 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $6,918.31
| Facility | | $275.42 | $371.54 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $6,918.31
| Professional | | $295.12 | $416.87 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $616.60
| Professional | | $229.09 | $363.08 | $616.60 |