- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,388.44 / $5,623.41
| Facility | | $588.84 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,096.48 / $3,801.89
| Professional | | $588.84 | $1,096.48 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,370.32 / $14,125.38
| Facility | | $56.23 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,380.38 / $6,165.95
| Professional | | $660.69 | $1,380.38 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,819.70 / $3,162.28
| Professional | | $1,122.02 | $1,819.70 | $3,162.28 |
- 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 / $1,148.15 / $2,137.96
| Professional | | $933.25 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $2,754.23
| Professional | | $851.14 | $1,479.11 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,888.44 / $14,125.38
| Facility | | $56.23 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,380.38 / $6,165.95
| Professional | | $660.69 | $1,380.38 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $3,548.13
| Professional | | $1,023.29 | $1,548.82 | $3,548.13 |