- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,412.54 / $1,412.54
| Facility | | $616.60 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $407.38 / $537.03
| Professional | | $354.81 | $407.38 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $69.18 / $1,513.56
| Professional | | $58.88 | $69.18 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $2,630.27
| Facility | | $1,412.54 | $1,621.81 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $758.58 / $1,584.89
| Professional | | $588.84 | $758.58 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,778.28 / $2,951.21
| Facility | | $309.03 | $1,778.28 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $2,398.83
| Facility | | $309.03 | $478.63 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $912.01
| Professional | | $257.04 | $309.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $257.04
| Professional | | $50.12 | $54.95 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,174.90 / $1,659.59
| Professional | | $660.69 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $2,398.83
| Facility | | $1,023.29 | $1,023.29 | $2,398.83 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,754.23 / $3,890.45
| Professional | | $1,479.11 | $2,754.23 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $616.60
| Facility | | $407.38 | $407.38 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $977.24
| Professional | | $213.80 | $309.03 | $977.24 |