- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,047.13 / $6,456.54
| Facility | | $407.38 | $1,047.13 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $758.58 / $1,318.26
| Professional | | $331.13 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,182.57
| Facility | | $5,011.87 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,318.26 / $3,548.13
| Professional | | $549.54 | $1,318.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $4,073.80
| Facility | | $2,187.76 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,148.15 / $2,951.21
| Professional | | $602.56 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,659.59 / $5,754.40
| Facility | | $371.54 | $1,659.59 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $2,344.23
| Professional | | $758.58 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,981.07 / $11,481.54
| Facility | | $363.08 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,995.26 / $4,897.79
| Professional | | $1,047.13 | $1,995.26 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $1,348.96
| Professional | | $32.36 | $50.12 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,380.38 / $2,951.21
| Professional | | $707.95 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,912.51 / $8,912.51
| Facility | | $6,165.95 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $4,168.69 / $6,606.93
| Professional | | $602.56 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $5,623.41
| Professional | | $1,621.81 | $2,511.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,258.93 / $3,548.13
| Professional | | $426.58 | $1,258.93 | $3,548.13 |