- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.31 / $4,518.60 / $13,841.56
| Facility | | $442.31 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.63 / $442.31 / $1,657.48
| Professional | | $293.63 | $442.31 | $1,657.48 |
- 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
- $334.50 / $613.89 / $909.92
| Professional | | $334.50 | $613.89 | $909.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.91 / $428.91 / $428.91
| Facility | | $428.91 | $428.91 | $428.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.92 / $936.56 / $1,382.90
| Professional | | $575.92 | $936.56 | $1,382.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.24 / $593.48 / $1,592.16
| Facility | | $372.24 | $593.48 | $1,592.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.83 / $987.07 / $2,541.12
| Professional | | $596.83 | $987.07 | $2,541.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.32 / $846.80 / $1,269.45
| Facility | | $480.32 | $846.80 | $1,269.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.77 / $896.39 / $1,269.45
| Professional | | $671.77 | $896.39 | $1,269.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.64 / $628.80 / $964.49
| Professional | | $360.64 | $628.80 | $964.49 |
- 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
- $558.19 / $987.07 / $1,285.48
| Professional | | $558.19 | $987.07 | $1,285.48 |