- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,388.44 / $5,623.41
| Facility | | $616.60 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $676.08 / $1,778.28
| Professional | | $588.84 | $676.08 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,548.82 / $5,011.87
| Facility | | $56.23 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $6,456.54
| Professional | | $588.84 | $954.99 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $1,698.24
| Professional | | $851.14 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $741.31 / $1,380.38
| Facility | | $50.12 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $851.14 / $1,737.80
| Professional | | $467.74 | $851.14 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $933.25 / $8,511.38
| Facility | | $302.00 | $933.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,230.27
| Professional | | $588.84 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $1,513.56
| Professional | | $562.34 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,548.82 / $5,011.87
| Facility | | $56.23 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $6,456.54
| Professional | | $588.84 | $954.99 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $933.25 / $1,737.80
| Professional | | $588.84 | $933.25 | $1,737.80 |