- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.47 / $1,375.19 / $2,180.19
| Facility | | $421.47 | $1,375.19 | $2,180.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.74 / $421.47 / $487.70
| Professional | | $358.74 | $421.47 | $487.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.77 / $1,040.35 / $2,840.07
| Facility | | $441.77 | $1,040.35 | $2,840.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.75 / $597.91 / $2,245.17
| Professional | | $358.75 | $597.91 | $2,245.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.33 / $1,358.97 / $2,375.83
| Facility | | $950.33 | $1,358.97 | $2,375.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.04 / $562.04 / $591.92
| Professional | | $562.04 | $562.04 | $591.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.98 / $432.55 / $1,165.69
| Facility | | $392.98 | $432.55 | $1,165.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.78 / $630.90 / $2,668.02
| Professional | | $349.78 | $630.90 | $2,668.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.55 / $862.55 / $1,014.77
| Professional | | $862.55 | $862.55 | $1,014.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $597.91 / $1,851.67
| Professional | | $597.91 | $597.91 | $1,851.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.35 / $2,840.07 / $2,840.07
| Facility | | $1,040.35 | $2,840.07 | $2,840.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.06 / $361.26 / $2,989.55
| Professional | | $269.06 | $361.26 | $2,989.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.12 / $361.26 / $1,006.16
| Professional | | $251.12 | $361.26 | $1,006.16 |