- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,818.38 / $5,128.61
| Facility | | $457.09 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $1,023.29
| Professional | | $371.54 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,265.80 / $28,840.32
| Facility | | $933.25 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,445.44
| Professional | | $346.74 | $575.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $1,047.13
| Facility | | $457.09 | $457.09 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,412.54 / $1,412.54
| Professional | | $602.56 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,445.44
| Professional | | $398.11 | $758.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $741.31 / $7,079.46
| Facility | | $346.74 | $741.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $891.25
| Professional | | $512.86 | $660.69 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,258.93
| Professional | | $407.38 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,265.80 / $28,840.32
| Facility | | $933.25 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,445.44
| Professional | | $346.74 | $575.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,258.93
| Professional | | $407.38 | $575.44 | $1,258.93 |