- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,388.44 / $5,623.41
| Facility | | $549.54 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $2,041.74
| Professional | | $588.84 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $7,244.36
| Facility | | $56.23 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,023.29 / $5,128.61
| Professional | | $575.44 | $1,023.29 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $2,454.71
| Professional | | $851.14 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,230.27 / $8,511.38
| Facility | | $302.00 | $1,230.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,513.56
| Professional | | $831.76 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,318.26 / $1,949.84
| Professional | | $741.31 | $1,318.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $7,244.36
| Facility | | $56.23 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,023.29 / $5,128.61
| Professional | | $575.44 | $1,023.29 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $2,089.30
| Professional | | $724.44 | $1,023.29 | $2,089.30 |