- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $4,897.79
| Facility | | $602.56 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,258.93
| Professional | | $436.52 | $602.56 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $28,840.32
| Facility | | $1,023.29 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $1,819.70
| Professional | | $426.58 | $724.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,202.26
| Facility | | $524.81 | $524.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,348.96
| Professional | | $912.01 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $812.83 / $1,479.11
| Professional | | $436.52 | $812.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $912.01 / $7,079.46
| Facility | | $426.58 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,148.15
| Professional | | $660.69 | $831.76 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $1,513.56
| Professional | | $501.19 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $28,840.32
| Facility | | $1,023.29 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $1,819.70
| Professional | | $426.58 | $724.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,548.82
| Professional | | $489.78 | $776.25 | $1,548.82 |