- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $5,623.41
| Facility | | $446.68 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $588.84
| Professional | | $354.81 | $436.52 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,023.29 / $4,073.80
| Facility | | $56.23 | $1,023.29 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $1,023.29
| Professional | | $208.93 | $380.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $891.25
| Professional | | $446.68 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $1,258.93
| Professional | | $416.87 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $8,511.38
| Facility | | $275.42 | $426.58 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $380.19 / $524.81
| Professional | | $316.23 | $380.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $630.96
| Professional | | $234.42 | $338.84 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $4,265.80
| Facility | | $56.23 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $1,023.29
| Professional | | $208.93 | $380.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $758.58
| Professional | | $275.42 | $380.19 | $758.58 |