- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,238.72 / $3,801.89
| Facility | | $630.96 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $630.96 / $1,548.82
| Professional | | $346.74 | $630.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,890.45 / $19,498.45
| Facility | | $812.83 | $3,890.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $2,754.23
| Professional | | $389.05 | $831.76 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,148.15
| Facility | | $501.19 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $1,621.81
| Professional | | $426.58 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $7,079.46
| Facility | | $380.19 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $1,949.84
| Professional | | $1,202.26 | $1,513.56 | $1,949.84 |
- 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
- $512.86 / $1,122.02 / $2,884.03
| Professional | | $512.86 | $1,122.02 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,890.45 / $19,498.45
| Facility | | $812.83 | $3,890.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $2,754.23
| Professional | | $389.05 | $831.76 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $2,511.89
| Professional | | $426.58 | $851.14 | $2,511.89 |