- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,630.27 / $8,317.64
| Facility | | $380.19 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $831.76
| Professional | | $295.12 | $436.52 | $831.76 |
- 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
- $331.13 / $501.19 / $812.83
| Professional | | $331.13 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $323.59 / $4,897.79
| Professional | | $281.84 | $323.59 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $524.81
| Facility | | $295.12 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $776.25
| Professional | | $302.00 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,000.00
| Professional | | $489.78 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $588.84
| Professional | | $426.58 | $478.63 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $776.25
| Facility | | $316.23 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $741.31
| Professional | | $354.81 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $1,445.44
| Facility | | $295.12 | $363.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $1,995.26
| Professional | | $371.54 | $512.86 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,025.60 / $13,803.84
| Facility | | $1,071.52 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $707.95
| Professional | | $263.03 | $416.87 | $707.95 |