- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $5,495.41 / $9,332.54
| Facility | | $478.63 | $5,495.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $2,951.21
| Professional | | $478.63 | $478.63 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,585.78 / $15,135.61
| Facility | | $3,467.37 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $11,748.98
| Professional | | $1,905.46 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,454.71 / $5,128.61
| Facility | | $2,089.30 | $2,454.71 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $4,570.88
| Professional | | $3,890.45 | $3,890.45 | $4,570.88 |
- 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
- $4,570.88 / $4,570.88 / $5,370.32
| Professional | | $4,570.88 | $4,570.88 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $6,760.83
| Professional | | $3,162.28 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,585.78 / $15,135.61
| Facility | | $3,467.37 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $11,748.98
| Professional | | $1,905.46 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $3,801.89
| Facility | | $1,905.46 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $6,456.54
| Professional | | $1,905.46 | $3,162.28 | $6,456.54 |