- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $4,897.79 / $7,943.28
| Facility | | $218.78 | $4,897.79 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $645.65 / $2,818.38
| Professional | | $239.88 | $645.65 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,709.64 / $19,054.61
| Facility | | $2,818.38 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,819.70 / $6,309.57
| Professional | | $416.87 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $19,054.61
| Facility | | $5,011.87 | $7,943.28 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $2,041.74 / $8,709.64
| Professional | | $524.81 | $2,041.74 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,585.78 / $15,135.61
| Facility | | $6,165.95 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,621.81 / $7,943.28
| Professional | | $512.86 | $1,621.81 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,019.95 / $7,244.36
| Facility | | $416.87 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $11,220.18
| Professional | | $2,238.72 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $12,589.25
| Facility | | $3,311.31 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,778.28 / $6,760.83
| Professional | | $398.11 | $1,778.28 | $6,760.83 |