- 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
- $177.83 / $204.17 / $457.09
| Professional | | $177.83 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $57,543.99
| Facility | | $3,801.89 | $4,466.84 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $194.98 / $354.81
| Professional | | $190.55 | $194.98 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $354.81
| Professional | | $151.36 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $269.15
| Professional | | $194.98 | $194.98 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $346.74
| Professional | | $162.18 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | | $5,248.07 | $5,248.07 | $5,248.07 |
- 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
- $181.97 / $239.88 / $707.95
| Professional | | $181.97 | $239.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $478.63
| Professional | | $239.88 | $331.13 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $199.53 / $199.53
| Facility | | $181.97 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $199.53 / $478.63
| Professional | | $181.97 | $199.53 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,168.69 / $12,022.64
| Facility | | $2,089.30 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $363.08
| Professional | | $158.49 | $204.17 | $363.08 |