- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,388.44 / $5,623.41
| Facility | | $407.38 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $2,454.71
| Professional | | $537.03 | $776.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $11,220.18
| Facility | | $56.23 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $912.01 / $4,365.16
| Professional | | $489.78 | $912.01 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,258.93 / $2,344.23
| Professional | | $724.44 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $851.14 / $8,511.38
| Facility | | $302.00 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,380.38
| Professional | | $602.56 | $741.31 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $954.99 / $1,737.80
| Professional | | $537.03 | $954.99 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $11,220.18
| Facility | | $56.23 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $912.01 / $4,365.16
| Professional | | $489.78 | $912.01 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,471.29
| Facility | | $2,041.74 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $2,290.87
| Professional | | $691.83 | $1,000.00 | $2,290.87 |