- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,691.53 / $3,715.35
| Facility | | $501.19 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $1,202.26
| Professional | | $331.13 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,897.79 / $28,840.32
| Facility | | $851.14 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,621.81
| Professional | | $398.11 | $660.69 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $977.24
| Facility | | $426.58 | $426.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,348.96
| Professional | | $426.58 | $741.31 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,288.25
| Professional | | $398.11 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $758.58 / $7,079.46
| Facility | | $346.74 | $758.58 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,023.29
| Professional | | $602.56 | $758.58 | $1,023.29 |
- 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
- $416.87 / $724.44 / $1,348.96
| Professional | | $416.87 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $6,918.31
| Facility | | $3,162.28 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $602.56
| Professional | | $275.42 | $275.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,897.79 / $28,840.32
| Facility | | $851.14 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,621.81
| Professional | | $398.11 | $660.69 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $1,380.38
| Professional | | $416.87 | $676.08 | $1,380.38 |