- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,630.78 / $6,456.54
| Facility | | $741.31 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,479.11
| Professional | | $478.63 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,168.69 / $16,218.10
| Facility | | $56.23 | $4,168.69 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $831.76 / $5,623.41
| Professional | | $478.63 | $831.76 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $831.76 / $1,445.44
| Professional | | $524.81 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $812.83 / $8,511.38
| Facility | | $302.00 | $812.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $933.25
| Professional | | $537.03 | $676.08 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $1,348.96
| Professional | | $512.86 | $912.01 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,168.69 / $16,218.10
| Facility | | $56.23 | $4,168.69 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $831.76 / $5,623.41
| Professional | | $478.63 | $831.76 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $870.96 / $1,479.11
| Professional | | $562.34 | $870.96 | $1,479.11 |