- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,388.44 / $5,623.41
| Facility | | $776.25 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $870.96 / $2,089.30
| Professional | | $758.58 | $870.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $7,244.36
| Facility | | $56.23 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $5,888.44
| Professional | | $758.58 | $1,230.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $741.31
| Facility | | $676.08 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,148.15 / $2,290.87
| Professional | | $562.34 | $1,148.15 | $2,290.87 |
- 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
- $831.76 / $1,148.15 / $1,698.24
| Professional | | $831.76 | $1,148.15 | $1,698.24 |
- 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
- $812.83 / $1,445.44 / $2,187.76
| Professional | | $812.83 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $7,244.36
| Facility | | $56.23 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,230.27 / $5,888.44
| Professional | | $776.25 | $1,230.27 | $5,888.44 |
- 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
- $812.83 / $1,288.25 / $2,344.23
| Professional | | $812.83 | $1,288.25 | $2,344.23 |