- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $6,456.54 / $8,709.64
| Facility | | $676.08 | $6,456.54 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,258.93 / $5,888.44
| Professional | | $354.81 | $1,258.93 | $5,888.44 |
- 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
- $575.44 / $1,949.84 / $6,456.54
| Professional | | $575.44 | $1,949.84 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,677.35 / $7,413.10
| Facility | | $3,981.07 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,174.90 / $5,370.32
| Professional | | $616.60 | $1,174.90 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $6,165.95 / $13,489.63
| Facility | | $426.58 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $4,265.80
| Professional | | $794.33 | $1,148.15 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $6,309.57 / $12,302.69
| Facility | | $389.05 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,467.37 / $8,317.64
| Professional | | $1,905.46 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $2,290.87
| Professional | | $32.36 | $50.12 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,548.82 / $4,897.79
| Professional | | $691.83 | $1,548.82 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $12,022.64
| Facility | | $6,165.95 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $3,090.30 / $10,232.93
| Professional | | $575.44 | $3,090.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,456.54 / $10,232.93
| Professional | | $1,905.46 | $6,456.54 | $10,232.93 |
- 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
- $489.78 / $1,778.28 / $6,309.57
| Professional | | $489.78 | $1,778.28 | $6,309.57 |