- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $8,317.64
| Facility | | $831.76 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $1,202.26
| Professional | | $380.19 | $467.74 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $776.25
| Professional | | $371.54 | $537.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $831.76
| Professional | | $398.11 | $524.81 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $660.69
| Professional | | $467.74 | $602.56 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $831.76
| Professional | | $398.11 | $537.03 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,344.23 / $8,317.64
| Facility | | $660.69 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,380.38
| Professional | | $389.05 | $562.34 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $851.14
| Facility | | $549.54 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $891.25
| Professional | | $512.86 | $676.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $457.09
| Facility | | $309.03 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $457.09
| Professional | | $309.03 | $398.11 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,311.31 / $6,606.93
| Facility | | $1,348.96 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $851.14
| Professional | | $363.08 | $489.78 | $851.14 |