- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,089.30 / $10,232.93
| Facility | | $346.74 | $2,089.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $416.87 / $1,445.44
| Professional | | $151.36 | $416.87 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $181.97 / $645.65
| Professional | | $66.07 | $181.97 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $575.44
| Professional | | $173.78 | $295.12 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $489.78
| Professional | | $162.18 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $338.84 / $2,089.30
| Professional | | $151.36 | $338.84 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $489.78 / $2,691.53
| Professional | | $199.53 | $489.78 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $323.59 / $323.59
| Professional | | $131.83 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,951.21 / $7,244.36
| Facility | | $1,288.25 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $501.19
| Professional | | $162.18 | $269.15 | $501.19 |