- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,090.30 / $5,623.41
| Facility | | $741.31 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $851.14 / $2,041.74
| Professional | | $707.95 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,819.70 / $6,165.95
| Facility | | $56.23 | $1,819.70 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $5,495.41
| Professional | | $707.95 | $1,122.02 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,023.29 / $2,137.96
| Professional | | $512.86 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,230.27 / $8,511.38
| Facility | | $302.00 | $1,230.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,548.82
| Professional | | $776.25 | $1,071.52 | $1,548.82 |
- 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
- $758.58 / $1,348.96 / $2,041.74
| Professional | | $758.58 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,819.70 / $6,165.95
| Facility | | $56.23 | $1,819.70 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $5,495.41
| Professional | | $707.95 | $1,096.48 | $5,495.41 |
- 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
- $707.95 / $1,096.48 / $2,238.72
| Professional | | $707.95 | $1,096.48 | $2,238.72 |