- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,691.53 / $4,365.16
| Facility | | $812.83 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $1,288.25
| Professional | | $229.09 | $331.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,128.61 / $28,840.32
| Facility | | $575.44 | $5,128.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $2,089.30
| Professional | | $186.21 | $363.08 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $851.14
| Professional | | $269.15 | $457.09 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $501.19 / $7,079.46
| Facility | | $223.87 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $251.19 / $371.54
| Professional | | $128.82 | $251.19 | $371.54 |
- 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
- $229.09 / $426.58 / $676.08
| Professional | | $229.09 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $5,888.44
| Facility | | $2,951.21 | $4,365.16 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,370.32 / $28,840.32
| Facility | | $575.44 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $2,089.30
| Professional | | $186.21 | $363.08 | $2,089.30 |
- 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
- $263.03 / $380.19 / $891.25
| Professional | | $263.03 | $380.19 | $891.25 |