- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,128.61 / $8,709.64
| Facility | | $537.03 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $4,786.30
| Professional | | $269.15 | $562.34 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $2,041.74
| Facility | | $1,096.48 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $707.95 / $6,606.93
| Professional | | $331.13 | $707.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $6,309.57
| Professional | | $457.09 | $691.83 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,398.83 / $5,754.40
| Facility | | $275.42 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $2,454.71 / $6,165.95
| Professional | | $426.58 | $2,454.71 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,570.88 / $5,888.44
| Facility | | $3,715.35 | $4,570.88 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $831.76 / $5,623.41
| Facility | | $269.15 | $831.76 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $724.44 / $6,606.93
| Professional | | $338.84 | $724.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,715.35 / $4,466.84
| Facility | | $2,818.38 | $3,715.35 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $4,168.69 / $6,606.93
| Professional | | $512.86 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $7,244.36
| Facility | | $1,548.82 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $812.83 / $6,918.31
| Professional | | $426.58 | $812.83 | $6,918.31 |