- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,090.30 / $5,128.61
| Facility | | $416.87 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $851.14
| Professional | | $263.03 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,897.79 / $45,708.82
| Facility | | $660.69 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $1,258.93
| Professional | | $309.03 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $758.58
| Facility | | $338.84 | $338.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,148.15
| Professional | | $338.84 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $1,047.13
| Professional | | $309.03 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $588.84 / $7,079.46
| Facility | | $275.42 | $588.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $588.84 / $812.83
| Professional | | $478.63 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,071.52
| Professional | | $323.59 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,897.79 / $45,708.82
| Facility | | $660.69 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $1,258.93
| Professional | | $309.03 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $1,096.48
| Professional | | $323.59 | $549.54 | $1,096.48 |