- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,235.94 / $8,317.64
| Facility | | $302.00 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $281.84 / $549.54
| Professional | | $239.88 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $501.19
| Professional | | $251.19 | $331.13 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $2,454.71
| Professional | | $245.47 | $288.40 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,454.71 / $3,019.95
| Facility | | $524.81 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $524.81
| Professional | | $257.04 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $269.15 / $537.03
| Professional | | $223.87 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $524.81
| Facility | | $257.04 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $1,148.15
| Facility | | $263.03 | $338.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $1,148.15
| Professional | | $263.03 | $338.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $5,754.40
| Facility | | $512.86 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $512.86
| Professional | | $213.80 | $302.00 | $512.86 |