- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,090.30 / $5,128.61
| Facility | | $812.83 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $1,584.89
| Professional | | $524.81 | $660.69 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,025.60 / $45,708.82
| Facility | | $1,380.38 | $6,025.60 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $4,168.69
| Professional | | $524.81 | $891.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,174.90 / $1,584.89
| Professional | | $691.83 | $1,174.90 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,621.81
| Professional | | $562.34 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,202.26 / $7,079.46
| Facility | | $549.54 | $1,202.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,047.13
| Professional | | $616.60 | $776.25 | $1,047.13 |
- 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
- $562.34 / $1,047.13 / $1,659.59
| Professional | | $562.34 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,570.88 / $4,570.88
| Facility | | $4,466.84 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,025.60 / $45,708.82
| Facility | | $1,380.38 | $6,025.60 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $4,168.69
| Professional | | $524.81 | $891.25 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $14,125.38
| Facility | | $2,570.40 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,698.24
| Professional | | $588.84 | $891.25 | $1,698.24 |