- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,570.40 / $7,079.46
| Facility | | $380.19 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $645.65
| Professional | | $213.80 | $323.59 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $562.34
| Professional | | $234.42 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $245.47 / $3,162.28
| Professional | | $213.80 | $245.47 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $660.69
| Facility | | $323.59 | $616.60 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $602.56
| Professional | | $245.47 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $398.11 / $660.69
| Professional | | $323.59 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $426.58 / $562.34
| Professional | | $407.38 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $630.96
| Facility | | $239.88 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $645.65
| Professional | | $338.84 | $338.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $1,000.00
| Facility | | $223.87 | $302.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $1,445.44
| Professional | | $331.13 | $416.87 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $5,754.40
| Facility | | $512.86 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $575.44
| Professional | | $208.93 | $338.84 | $575.44 |