- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,238.72 / $3,801.89
| Facility | | $446.68 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $1,202.26
| Professional | | $331.13 | $446.68 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,128.61 / $19,498.45
| Facility | | $831.76 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,318.26
| Professional | | $323.59 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $912.01
| Facility | | $398.11 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $1,479.11
| Professional | | $446.68 | $724.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $660.69 / $7,079.46
| Facility | | $309.03 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $776.25
| Professional | | $269.15 | $512.86 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $1,174.90
| Professional | | $380.19 | $645.65 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,370.32 / $19,498.45
| Facility | | $831.76 | $5,370.32 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,288.25
| Professional | | $323.59 | $562.34 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,258.93
| Professional | | $389.05 | $676.08 | $1,258.93 |