- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $5,623.41
| Facility | | $724.44 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $2,691.53
| Professional | | $794.33 | $1,047.13 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,290.87 / $7,244.36
| Facility | | $56.23 | $2,290.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,380.38 / $6,606.93
| Professional | | $794.33 | $1,380.38 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $3,162.28
| Professional | | $1,096.48 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,513.56 / $8,511.38
| Facility | | $302.00 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $1,995.26
| Professional | | $1,047.13 | $1,288.25 | $1,995.26 |
- 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
- $933.25 / $1,659.59 / $2,454.71
| Professional | | $933.25 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,290.87 / $7,244.36
| Facility | | $56.23 | $2,290.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $6,606.93
| Professional | | $794.33 | $1,348.96 | $6,606.93 |
- 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
- $1,023.29 / $1,412.54 / $2,630.27
| Professional | | $1,023.29 | $1,412.54 | $2,630.27 |