- 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
- $549.54 / $1,023.29 / $3,467.37
| Professional | | $549.54 | $1,023.29 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,041.74 / $7,244.36
| Facility | | $56.23 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $8,709.64
| Professional | | $645.65 | $1,258.93 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $3,019.95
| Professional | | $1,096.48 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,380.38 / $8,511.38
| Facility | | $302.00 | $1,380.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $1,905.46
| Professional | | $977.24 | $1,174.90 | $1,905.46 |
- 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
- $851.14 / $1,202.26 / $2,290.87
| Professional | | $851.14 | $1,202.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,041.74 / $7,244.36
| Facility | | $56.23 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $8,709.64
| Professional | | $645.65 | $1,258.93 | $8,709.64 |
- 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
- $1,000.00 / $1,380.38 / $2,630.27
| Professional | | $1,000.00 | $1,380.38 | $2,630.27 |