- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $8,317.64
| Facility | | $831.76 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,584.89
| Professional | | $537.03 | $645.65 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,122.02
| Professional | | $524.81 | $776.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,202.26
| Professional | | $562.34 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $891.25
| Professional | | $630.96 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,174.90
| Professional | | $575.44 | $776.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,344.23 / $8,317.64
| Facility | | $660.69 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,862.09
| Professional | | $549.54 | $758.58 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,202.26
| Facility | | $812.83 | $812.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,258.93
| Professional | | $724.44 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $660.69
| Facility | | $309.03 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $602.56
| Professional | | $309.03 | $416.87 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $16,595.87
| Facility | | $912.01 | $2,754.23 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,230.27
| Professional | | $537.03 | $707.95 | $1,230.27 |