- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.50 / $4,778.89 / $13,841.56
| Facility | | $403.50 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.37 / $403.50 / $1,431.10
| Professional | | $268.37 | $403.50 | $1,431.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.80 / $332.80 / $648.42
| Professional | | $332.80 | $332.80 | $648.42 |
- 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
- $288.36 / $541.57 / $825.77
| Professional | | $288.36 | $541.57 | $825.77 |
- 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
- $505.11 / $847.41 / $1,260.19
| Professional | | $505.11 | $847.41 | $1,260.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.24 / $512.70 / $1,373.44
| Facility | | $321.24 | $512.70 | $1,373.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.41 / $903.69 / $2,191.12
| Professional | | $546.41 | $903.69 | $2,191.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.11 / $946.87 / $1,522.00
| Facility | | $644.11 | $946.87 | $1,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.24 / $813.49 / $1,158.96
| Professional | | $591.24 | $813.49 | $1,158.96 |
- 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
- $546.41 / $925.88 / $1,176.90
| Professional | | $546.41 | $925.88 | $1,176.90 |