- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,238.72 / $3,801.89
| Facility | | $436.52 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $1,174.90
| Professional | | $323.59 | $436.52 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,128.61 / $26,915.35
| Facility | | $812.83 | $5,128.61 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $1,318.26
| Professional | | $309.03 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $891.25
| Facility | | $389.05 | $389.05 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $1,445.44
| Professional | | $436.52 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $645.65 / $7,079.46
| Facility | | $302.00 | $645.65 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $741.31
| Professional | | $263.03 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $1,148.15
| Professional | | $363.08 | $616.60 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,370.32 / $26,915.35
| Facility | | $812.83 | $5,370.32 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $1,288.25
| Professional | | $309.03 | $549.54 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $12,589.25
| Facility | | $1,862.09 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $1,258.93
| Professional | | $380.19 | $660.69 | $1,258.93 |