- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $4,897.79
| Facility | | $524.81 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $549.54 / $1,380.38
| Professional | | $257.04 | $549.54 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,128.61 / $28,840.32
| Facility | | $616.60 | $5,128.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $676.08 / $2,041.74
| Professional | | $275.42 | $676.08 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $691.83
| Facility | | $295.12 | $295.12 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,819.70
| Professional | | $338.84 | $707.95 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $501.19 / $7,079.46
| Facility | | $234.42 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $707.95 / $1,174.90
| Professional | | $371.54 | $707.95 | $1,174.90 |
- 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
- $281.84 / $660.69 / $1,513.56
| Professional | | $281.84 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,370.32 / $28,840.32
| Facility | | $616.60 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $676.08 / $2,041.74
| Professional | | $275.42 | $676.08 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $724.44 / $2,041.74
| Professional | | $302.00 | $724.44 | $2,041.74 |