- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,715.35 / $6,918.31
| Facility | | $616.60 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $269.15 / $1,071.52
| Professional | | $177.83 | $269.15 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,570.88 / $11,220.18
| Facility | | $549.54 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $741.31
| Professional | | $190.55 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $851.14
| Professional | | $295.12 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $776.25
| Professional | | $239.88 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $501.19 / $7,079.46
| Facility | | $204.17 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $269.15 / $416.87
| Professional | | $147.91 | $269.15 | $416.87 |
- 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
- $245.47 / $398.11 / $645.65
| Professional | | $245.47 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $4,466.84
| Facility | | $2,511.89 | $3,388.44 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,897.79 / $11,220.18
| Facility | | $549.54 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $741.31
| Professional | | $190.55 | $331.13 | $741.31 |
- 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
- $245.47 / $380.19 / $724.44
| Professional | | $245.47 | $380.19 | $724.44 |