- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,388.44 / $5,623.41
| Facility | | $323.59 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $2,344.23
| Professional | | $457.09 | $602.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $5,623.41
| Facility | | $56.23 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,659.59
| Professional | | $346.74 | $707.95 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $977.24 / $1,659.59
| Professional | | $588.84 | $977.24 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $707.95 / $8,511.38
| Facility | | $302.00 | $707.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,047.13
| Professional | | $501.19 | $602.56 | $1,047.13 |
- 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
- $446.68 / $660.69 / $1,174.90
| Professional | | $446.68 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $5,623.41
| Facility | | $56.23 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,659.59
| Professional | | $346.74 | $707.95 | $1,659.59 |
- 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
- $524.81 / $812.83 / $1,445.44
| Professional | | $524.81 | $812.83 | $1,445.44 |