- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,818.38 / $5,623.41
| Facility | | $186.21 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $436.52 / $1,096.48
| Professional | | $190.55 | $436.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $5,248.07
| Facility | | $56.23 | $2,344.23 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $512.86 / $1,698.24
| Professional | | $223.87 | $512.86 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $562.34
| Facility | | $239.88 | $239.88 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $501.19 / $1,288.25
| Professional | | $239.88 | $501.19 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $436.52 / $7,079.46
| Facility | | $204.17 | $436.52 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $891.25 / $1,122.02
| Professional | | $741.31 | $891.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $645.65 / $1,621.81
| Professional | | $245.47 | $645.65 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $5,248.07
| Facility | | $56.23 | $2,344.23 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $512.86 / $1,698.24
| Professional | | $223.87 | $512.86 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $1,479.11
| Professional | | $239.88 | $512.86 | $1,479.11 |