- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,467.37 / $7,244.36
| Facility | | $354.81 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $645.65
| Professional | | $229.09 | $331.13 | $645.65 |
- 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
- $245.47 / $380.19 / $602.56
| Professional | | $245.47 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $269.15 / $3,890.45
| Professional | | $234.42 | $269.15 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,288.25 / $1,412.54
| Facility | | $426.58 | $1,288.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $588.84
| Professional | | $223.87 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $758.58
| Professional | | $371.54 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $331.13 / $501.19
| Professional | | $288.40 | $331.13 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $588.84
| Facility | | $229.09 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $512.86
| Professional | | $158.49 | $158.49 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $275.42 / $1,023.29
| Facility | | $194.98 | $275.42 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $1,412.54
| Professional | | $275.42 | $371.54 | $1,412.54 |
- 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
- $186.21 / $302.00 / $524.81
| Professional | | $186.21 | $302.00 | $524.81 |