- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,818.38 / $5,623.41
| Facility | | $457.09 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $478.63 / $1,318.26
| Professional | | $295.12 | $478.63 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,162.28 / $28,840.32
| Facility | | $741.31 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,412.54
| Professional | | $346.74 | $588.84 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $851.14
| Facility | | $371.54 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $645.65 / $1,202.26
| Professional | | $371.54 | $645.65 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $616.60 / $1,148.15
| Professional | | $338.84 | $616.60 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $645.65 / $7,079.46
| Facility | | $302.00 | $645.65 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $891.25
| Professional | | $524.81 | $660.69 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $1,174.90
| Professional | | $354.81 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $7,079.46
| Facility | | $3,890.45 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,162.28 / $28,840.32
| Facility | | $741.31 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,412.54
| Professional | | $346.74 | $588.84 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,230.27
| Professional | | $354.81 | $602.56 | $1,230.27 |