- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,570.40 / $7,079.46
| Facility | | $467.74 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $794.33
| Professional | | $295.12 | $407.38 | $794.33 |
- 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
- $316.23 / $457.09 / $724.44
| Professional | | $316.23 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $323.59 / $13,489.63
| Professional | | $288.40 | $323.59 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $616.60
| Facility | | $251.19 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $741.31
| Professional | | $309.03 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $812.83
| Professional | | $398.11 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $537.03 / $676.08
| Professional | | $478.63 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $758.58
| Facility | | $323.59 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $831.76
| Professional | | $251.19 | $251.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $954.99
| Facility | | $302.00 | $407.38 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $1,148.15
| Professional | | $389.05 | $512.86 | $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
- $275.42 / $426.58 / $707.95
| Professional | | $275.42 | $426.58 | $707.95 |