- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,090.30 / $8,511.38
| Facility | | $389.05 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $1,445.44
| Professional | | $645.65 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,023.29 / $3,467.37
| Facility | | $56.23 | $1,023.29 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $549.54 / $1,778.28
| Professional | | $223.87 | $549.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $3,162.28
| Professional | | $1,047.13 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $8,511.38
| Facility | | $302.00 | $676.08 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $575.44 / $1,071.52
| Professional | | $478.63 | $575.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,023.29
| Professional | | $389.05 | $562.34 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,023.29 / $3,467.37
| Facility | | $56.23 | $1,023.29 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $549.54 / $1,778.28
| Professional | | $223.87 | $549.54 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,148.15
| Professional | | $363.08 | $562.34 | $1,148.15 |