- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,238.72 / $5,128.61
| Facility | | $794.33 | $2,238.72 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $2,041.74
| Professional | | $660.69 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $4,897.79
| Facility | | $56.23 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,122.02 / $2,818.38
| Professional | | $630.96 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,949.84
| Facility | | $851.14 | $851.14 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,202.26 / $2,238.72
| Professional | | $676.08 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,548.82 / $7,079.46
| Facility | | $501.19 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $1,737.80
| Professional | | $1,023.29 | $1,258.93 | $1,737.80 |
- 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
- $812.83 / $1,318.26 / $2,238.72
| Professional | | $812.83 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $4,897.79
| Facility | | $56.23 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,122.02 / $2,818.38
| Professional | | $630.96 | $1,122.02 | $2,818.38 |
- 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
- $660.69 / $1,122.02 / $2,344.23
| Professional | | $660.69 | $1,122.02 | $2,344.23 |