- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,388.44 / $5,623.41
| Facility | | $851.14 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $2,454.71
| Professional | | $794.33 | $933.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,630.78 / $15,135.61
| Facility | | $56.23 | $3,630.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $9,120.11
| Professional | | $794.33 | $1,348.96 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $5,623.41
| Facility | | $446.68 | $741.31 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,148.15 / $2,344.23
| Professional | | $512.86 | $1,148.15 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,348.96 / $8,511.38
| Facility | | $302.00 | $1,348.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $1,737.80
| Professional | | $831.76 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,445.44 / $2,238.72
| Professional | | $812.83 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,630.78 / $15,135.61
| Facility | | $56.23 | $3,630.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $9,120.11
| Professional | | $812.83 | $1,348.96 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $13,182.57
| Facility | | $1,584.89 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $2,454.71
| Professional | | $812.83 | $1,318.26 | $2,454.71 |