- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.96 / $4,239.39 / $7,209.14
| Facility | | $829.96 | $4,239.39 | $7,209.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.16 / $227.16 / $532.82
| Professional | | $192.16 | $227.16 | $532.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.24 / $198.24 / $198.24
| Professional | | $198.24 | $198.24 | $198.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $355.31 / $560.91
| Professional | | $261.33 | $355.31 | $560.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.32 / $325.43 / $524.39
| Professional | | $221.32 | $325.43 | $524.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.39 / $267.44 / $494.04
| Facility | | $192.39 | $267.44 | $494.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.44 / $267.44 / $487.58
| Professional | | $267.44 | $267.44 | $487.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,559.73 / $5,559.73 / $5,559.73
| Facility | | $5,559.73 | $5,559.73 | $5,559.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.72 / $310.81 / $413.50
| Professional | | $281.72 | $310.81 | $413.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.00 / $6,575.00 / $9,616.00
| Facility | | $2,353.00 | $6,575.00 | $9,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.15 / $275.23 / $550.96
| Professional | | $190.15 | $275.23 | $550.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.52 / $5,444.45 / $16,394.00
| Facility | | $731.52 | $5,444.45 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.00 / $1,656.00 / $1,656.00
| Professional | | $1,656.00 | $1,656.00 | $1,656.00 |