- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,388.44 / $5,623.41
| Facility | | $707.95 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $4,265.80
| Professional | | $707.95 | $1,318.26 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $7,762.47
| Facility | | $56.23 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,479.11 / $7,413.10
| Professional | | $758.58 | $1,479.11 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,187.76 / $3,801.89
| Professional | | $1,348.96 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,584.89 / $8,511.38
| Facility | | $302.00 | $1,584.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,290.87
| Professional | | $1,122.02 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $3,019.95
| Professional | | $1,000.00 | $1,584.89 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,290.87 / $7,762.47
| Facility | | $56.23 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,479.11 / $7,413.10
| Professional | | $758.58 | $1,479.11 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $6,165.95
| Facility | | $891.25 | $2,089.30 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,548.82 / $3,467.37
| Professional | | $794.33 | $1,548.82 | $3,467.37 |