- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $7,244.36
| Facility | | $616.60 | $3,162.28 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,288.25 / $2,454.71
| Professional | | $363.08 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,122.02 / $2,398.83
| Professional | | $371.54 | $1,122.02 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $416.87 / $4,365.16
| Professional | | $338.84 | $416.87 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $891.25 / $2,630.27
| Professional | | $398.11 | $891.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,584.89 / $1,995.26
| Professional | | $1,318.26 | $1,584.89 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,288.25 / $2,754.23
| Facility | | $407.38 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $7,413.10
| Facility | | $346.74 | $478.63 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $7,585.78
| Professional | | $1,380.38 | $2,041.74 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,332.54 / $19,054.61
| Facility | | $5,495.41 | $9,332.54 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,148.15 / $2,818.38
| Professional | | $354.81 | $1,148.15 | $2,818.38 |