- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,801.89 / $6,025.60
| Facility | | $229.09 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $549.54
| Professional | | $229.09 | $288.40 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,918.31 / $15,848.93
| Facility | | $3,801.89 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $870.96
| Professional | | $363.08 | $537.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $2,089.30
| Facility | | $616.60 | $870.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | 22 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,122.02
| Professional | | $489.78 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,621.81
| Facility | | $676.08 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $954.99
| Professional | | $446.68 | $630.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,258.93 / $7,762.47
| Facility | | $323.59 | $1,258.93 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,071.52
| Professional | | $302.00 | $501.19 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $9,120.11
| Facility | | $2,884.03 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $954.99
| Professional | | $288.40 | $501.19 | $954.99 |