- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,754.23 / $4,897.79
| Facility | | $398.11 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $346.74 / $870.96
| Professional | | $154.88 | $346.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,949.84 / $28,840.32
| Facility | | $389.05 | $1,949.84 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $436.52 / $1,148.15
| Professional | | $173.78 | $436.52 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $446.68
| Facility | | $190.55 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $501.19 / $1,096.48
| Professional | | $213.80 | $501.19 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $501.19 / $7,079.46
| Facility | | $151.36 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $436.52 / $645.65
| Professional | | $229.09 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $954.99
| Professional | | $177.83 | $416.87 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,995.26 / $28,840.32
| Facility | | $389.05 | $1,995.26 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $426.58 / $1,148.15
| Professional | | $173.78 | $426.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,290.87 / $6,165.95
| Facility | | $954.99 | $2,290.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $457.09 / $977.24
| Professional | | $186.21 | $457.09 | $977.24 |