- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,238.72 / $2,398.83
| Facility | | $223.87 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $549.54 / $3,801.89
| Professional | | $234.42 | $549.54 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,238.72 / $5,370.32
| Facility | | $575.44 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,778.28 / $7,413.10
| Professional | | $426.58 | $1,778.28 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,912.51 / $21,379.62
| Facility | | $5,495.41 | $8,912.51 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,621.81 / $9,332.54
| Professional | | $489.78 | $1,621.81 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $16,982.44
| Facility | | $6,918.31 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $3,311.31 / $8,511.38
| Professional | | $512.86 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,380.38 / $5,248.07
| Facility | | $263.03 | $1,380.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,754.40 / $17,378.01
| Professional | | $2,398.83 | $5,754.40 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,456.54
| Facility | | $1,230.27 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,258.93 / $7,762.47
| Professional | | $275.42 | $1,258.93 | $7,762.47 |