- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,388.44 / $8,511.38
| Facility | | $512.86 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $954.99 / $3,090.30
| Professional | | $512.86 | $954.99 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,905.46 / $7,244.36
| Facility | | $56.23 | $1,905.46 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $8,511.38
| Professional | | $602.56 | $1,202.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $2,884.03
| Professional | | $1,023.29 | $1,621.81 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,318.26 / $8,511.38
| Facility | | $302.00 | $1,318.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,096.48 / $1,737.80
| Professional | | $933.25 | $1,096.48 | $1,737.80 |
- 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
- $794.33 / $1,122.02 / $2,137.96
| Professional | | $794.33 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,905.46 / $7,244.36
| Facility | | $56.23 | $1,905.46 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $8,511.38
| Professional | | $602.56 | $1,202.26 | $8,511.38 |
- 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
- $912.01 / $1,258.93 / $2,454.71
| Professional | | $912.01 | $1,258.93 | $2,454.71 |