- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.19 / $4,778.89 / $13,841.56
| Facility | | $426.19 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.06 / $426.19 / $1,620.58
| Professional | | $290.06 | $426.19 | $1,620.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.44 / $460.44 / $460.44
| Professional | | $460.44 | $460.44 | $460.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,063.17 / $11,728.12
| Facility | | $4,609.82 | $6,063.17 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.16 / $579.38 / $872.25
| Professional | | $309.16 | $579.38 | $872.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,062.42 / $1,062.42
| Facility | | $1,062.42 | $1,062.42 | $1,062.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.41 / $895.08 / $1,323.50
| Professional | | $565.41 | $895.08 | $1,323.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.71 / $551.11 / $1,472.00
| Facility | | $344.71 | $551.11 | $1,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.91 / $973.49 / $2,350.00
| Professional | | $581.91 | $973.49 | $2,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.40 / $998.53 / $1,416.56
| Facility | | $691.40 | $998.53 | $1,416.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.20 / $861.22 / $1,223.16
| Professional | | $641.20 | $861.22 | $1,223.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.91 / $987.17 / $1,253.33
| Professional | | $581.91 | $987.17 | $1,253.33 |