- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,818.38 / $5,128.61
| Facility | | $478.63 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $1,174.90
| Professional | | $338.84 | $501.19 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,570.40 / $9,549.93
| Facility | | $56.23 | $2,570.40 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $3,801.89
| Professional | | $363.08 | $616.60 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $1,023.29
| Facility | | $446.68 | $446.68 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $831.76
| Facility | | $446.68 | $691.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $1,288.25
| Professional | | $316.23 | $588.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $630.96 / $8,511.38
| Facility | | $302.00 | $630.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,202.26
| Professional | | $630.96 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,445.44
| Professional | | $426.58 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,570.40 / $9,549.93
| Facility | | $56.23 | $2,570.40 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $3,801.89
| Professional | | $363.08 | $616.60 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $11,220.18
| Facility | | $1,071.52 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,412.54
| Professional | | $354.81 | $630.96 | $1,412.54 |