- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,238.72 / $3,801.89
| Facility | | $281.84 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $707.95
| Professional | | $245.47 | $309.03 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $19,498.45
| Facility | | $676.08 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $1,122.02
| Professional | | $245.47 | $426.58 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $776.25
| Facility | | $346.74 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $851.14
| Professional | | $275.42 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $630.96 / $7,079.46
| Facility | | $288.40 | $630.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $616.60
| Professional | | $407.38 | $501.19 | $616.60 |
- 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
- $338.84 / $549.54 / $912.01
| Professional | | $338.84 | $549.54 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $19,498.45
| Facility | | $676.08 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $1,122.02
| Professional | | $245.47 | $426.58 | $1,122.02 |
- 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
- $257.04 / $436.52 / $933.25
| Professional | | $257.04 | $436.52 | $933.25 |