- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.43 / $1,891.46 / $2,561.96
| Facility | | $413.43 | $1,891.46 | $2,561.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.43 / $413.43 / $1,294.59
| Professional | | $413.43 | $413.43 | $1,294.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.12 / $961.31 / $3,993.09
| Facility | | $621.12 | $961.31 | $3,993.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $4,203.25
| Professional | | $353.07 | $504.39 | $4,203.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.42 / $1,911.08 / $3,341.05
| Facility | | $1,336.42 | $1,911.08 | $3,341.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.53 / $655.70 / $1,912.47
| Facility | | $416.53 | $655.70 | $1,912.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.44 / $966.01 / $3,751.94
| Professional | | $504.44 | $966.01 | $3,751.94 |
- 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
- $1,213.08 / $1,213.08 / $1,427.15
| Professional | | $1,213.08 | $1,213.08 | $1,427.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.65 / $840.65 / $2,603.41
| Professional | | $840.65 | $840.65 | $2,603.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.73 / $3,993.09 / $3,993.09
| Facility | | $1,462.73 | $3,993.09 | $3,993.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $4,203.25
| Professional | | $353.07 | $504.39 | $4,203.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $504.39 / $1,501.45
| Professional | | $353.07 | $504.39 | $1,501.45 |