- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,238.72 / $3,801.89
| Facility | | $537.03 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,230.27
| Professional | | $446.68 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $3,548.13
| Facility | | $56.23 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $1,698.24
| Professional | | $407.38 | $676.08 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,288.25
| Facility | | $575.44 | $575.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $933.25 / $1,698.24
| Professional | | $457.09 | $933.25 | $1,698.24 |
- 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
- $602.56 / $776.25 / $1,047.13
| Professional | | $602.56 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,454.71 / $7,079.46
| Facility | | $794.33 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,380.38
| Professional | | $501.19 | $758.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,801.89
| Facility | | $56.23 | $1,288.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $1,698.24
| Professional | | $407.38 | $676.08 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,089.30 / $6,165.95
| Facility | | $776.25 | $2,089.30 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,412.54
| Professional | | $478.63 | $676.08 | $1,412.54 |