- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $7,943.28 / $14,454.40
| Facility | | $478.63 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $912.01
| Professional | | $177.83 | $234.42 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,466.84 / $8,709.64
| Facility | | $3,467.37 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $478.63
| Professional | | $199.53 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $691.83
| Professional | | $218.78 | $489.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $5,248.07
| Facility | | $223.87 | $380.19 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $2,511.89
| Professional | | $269.15 | $436.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $512.86 / $691.83
| Professional | | $467.74 | $512.86 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $524.81
| Professional | | $467.74 | $467.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $426.58 / $645.65
| Professional | | $3.98 | $426.58 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $8,128.31
| Facility | | $3,630.78 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $562.34
| Professional | | $269.15 | $416.87 | $562.34 |