- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $5,623.41
| Facility | | $794.33 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $2,454.71
| Professional | | $691.83 | $831.76 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $9,332.54
| Facility | | $56.23 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,148.15 / $9,772.37
| Professional | | $602.56 | $1,148.15 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,445.44 / $2,754.23
| Professional | | $794.33 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,174.90 / $8,511.38
| Facility | | $302.00 | $1,174.90 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $812.83 / $1,202.26
| Professional | | $426.58 | $812.83 | $1,202.26 |
- 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
- $724.44 / $1,348.96 / $2,187.76
| Professional | | $724.44 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,801.89 / $9,332.54
| Facility | | $56.23 | $3,801.89 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,148.15 / $9,772.37
| Professional | | $602.56 | $1,148.15 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,818.38
| Professional | | $851.14 | $1,230.27 | $2,818.38 |