- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,090.30 / $5,128.61
| Facility | | $691.83 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $870.96 / $1,905.46
| Professional | | $354.81 | $870.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,495.41 / $45,708.82
| Facility | | $794.33 | $5,495.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $912.01 / $2,454.71
| Professional | | $354.81 | $912.01 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $891.25
| Facility | | $380.19 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,148.15 / $2,344.23
| Professional | | $524.81 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $660.69 / $7,079.46
| Facility | | $309.03 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,398.83
| Professional | | $1,047.13 | $1,288.25 | $2,398.83 |
- 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
- $380.19 / $933.25 / $2,238.72
| Professional | | $380.19 | $933.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,495.41 / $45,708.82
| Facility | | $794.33 | $5,495.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $912.01 / $2,454.71
| Professional | | $354.81 | $912.01 | $2,454.71 |
- 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
- $436.52 / $1,122.02 / $2,398.83
| Professional | | $436.52 | $1,122.02 | $2,398.83 |