- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,388.44 / $5,623.41
| Facility | | $478.63 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $851.14 / $2,951.21
| Professional | | $478.63 | $851.14 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $8,709.64
| Facility | | $56.23 | $4,265.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,071.52 / $4,786.30
| Professional | | $512.86 | $1,071.52 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $2,454.71
| Professional | | $870.96 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,318.26 / $7,079.46
| Facility | | $501.19 | $1,318.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,659.59
| Professional | | $724.44 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,148.15 / $2,137.96
| Professional | | $645.65 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $8,709.64
| Facility | | $56.23 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,071.52 / $4,786.30
| Professional | | $512.86 | $1,071.52 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,471.29
| Facility | | $2,041.74 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $2,754.23
| Professional | | $831.76 | $1,202.26 | $2,754.23 |