- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.95 / $4,594.60 / $7,845.36
| Facility | | $260.95 | $4,594.60 | $7,845.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.74 / $577.36 / $910.63
| Professional | | $133.74 | $577.36 | $910.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.69 / $495.45 / $919.56
| Professional | | $128.69 | $495.45 | $919.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.34 / $148.34 / $298.16
| Professional | | $148.34 | $148.34 | $298.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.24 / $610.00 / $1,896.02
| Facility | | $222.24 | $610.00 | $1,896.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.49 / $356.00 / $1,249.56
| Professional | | $149.49 | $356.00 | $1,249.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.02 / $695.63 / $864.10
| Professional | | $553.02 | $695.63 | $864.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.61 / $651.50 / $1,223.68
| Facility | | $146.61 | $651.50 | $1,223.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.00 / $919.00 / $1,981.00
| Professional | | $783.00 | $919.00 | $1,981.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.87 / $188.64 / $319.35
| Facility | | $143.87 | $188.64 | $319.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.48 / $1,009.26 / $1,649.64
| Professional | | $766.48 | $1,009.26 | $1,649.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $8,246.00 / $17,187.00
| Facility | | $1,236.00 | $8,246.00 | $17,187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.10 / $947.73 / $1,449.62
| Professional | | $573.10 | $947.73 | $1,449.62 |