- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,630.78 / $8,317.64
| Facility | | $354.81 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $794.33
| Professional | | $263.03 | $309.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $537.03
| Professional | | $269.15 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $302.00 / $7,079.46
| Professional | | $263.03 | $302.00 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,235.94 / $3,548.13
| Facility | | $457.09 | $3,235.94 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $575.44
| Professional | | $275.42 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $295.12 / $562.34
| Professional | | $245.47 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $501.19 / $616.60
| Professional | | $457.09 | $501.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $398.11 / $616.60
| Facility | | $281.84 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $741.31
| Professional | | $338.84 | $338.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $1,318.26
| Facility | | $281.84 | $389.05 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $1,318.26
| Professional | | $281.84 | $389.05 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $8,317.64 / $19,054.61
| Facility | | $1,318.26 | $8,317.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $575.44
| Professional | | $229.09 | $354.81 | $575.44 |