- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,698.24 / $2,238.72
| Facility | | $501.19 | $1,698.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,905.46
| Professional | | $501.19 | $676.08 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $3,630.78
| Facility | | $831.76 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,238.72
| Professional | | $457.09 | $758.58 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $2,187.76
| Facility | | $1,202.26 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $741.31
| Professional | | $316.23 | $316.23 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,479.11
| Facility | | $346.74 | $588.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $1,995.26
| Professional | | $446.68 | $794.33 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,288.25
| Professional | | $1,096.48 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,258.93
| Professional | | $758.58 | $758.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $3,630.78
| Facility | | $831.76 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,511.89
| Professional | | $457.09 | $758.58 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $912.01
| Facility | | $457.09 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $1,348.96
| Professional | | $457.09 | $602.56 | $1,348.96 |