- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,818.38 / $5,128.61
| Facility | | $457.09 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $977.24
| Professional | | $275.42 | $407.38 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,981.07 / $28,840.32
| Facility | | $676.08 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $537.03 / $1,174.90
| Professional | | $295.12 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $741.31
| Facility | | $323.59 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $616.60 / $1,412.54
| Professional | | $309.03 | $616.60 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $7,079.46
| Facility | | $269.15 | $562.34 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $467.74 / $707.95
| Professional | | $245.47 | $467.74 | $707.95 |
- 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
- $309.03 / $537.03 / $1,023.29
| Professional | | $309.03 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,265.80 / $28,840.32
| Facility | | $676.08 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $537.03 / $1,174.90
| Professional | | $295.12 | $537.03 | $1,174.90 |
- 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
- $316.23 / $602.56 / $1,148.15
| Professional | | $316.23 | $602.56 | $1,148.15 |