- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,041.74 / $7,079.46
| Facility | | $467.74 | $2,041.74 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $812.83
| Professional | | $275.42 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $724.44
| Professional | | $302.00 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $309.03 / $2,570.40
| Professional | | $275.42 | $309.03 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $309.03 / $363.08
| Facility | | $275.42 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $741.31
| Professional | | $302.00 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $851.14
| Professional | | $416.87 | $524.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $602.56
| Professional | | $436.52 | $489.78 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $741.31
| Facility | | $295.12 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $758.58
| Professional | | $371.54 | $371.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $891.25
| Facility | | $288.40 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $1,148.15
| Professional | | $371.54 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $812.83 / $2,398.83
| Facility | | $109.65 | $812.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $676.08
| Professional | | $257.04 | $398.11 | $676.08 |