- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.69 / $4,778.89 / $13,841.56
| Facility | | $411.69 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.32 / $411.69 / $1,563.47
| Professional | | $274.32 | $411.69 | $1,563.47 |
- 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
- $292.88 / $550.08 / $842.09
| Professional | | $292.88 | $550.08 | $842.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.75 / $864.14 / $1,275.78
| Professional | | $535.75 | $864.14 | $1,275.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.82 / $521.21 / $1,396.08
| Facility | | $325.82 | $521.21 | $1,396.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.51 / $921.67 / $2,227.04
| Professional | | $557.51 | $921.67 | $2,227.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.29 / $962.15 / $2,842.49
| Facility | | $654.29 | $962.15 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.00 / $838.75 / $1,206.73
| Professional | | $590.00 | $838.75 | $1,206.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.16 / $549.51 / $888.39
| Professional | | $315.16 | $549.51 | $888.39 |
- 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
- $546.72 / $921.67 / $1,200.78
| Professional | | $546.72 | $921.67 | $1,200.78 |