- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,388.44 / $5,623.41
| Facility | | $537.03 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,659.59
| Professional | | $537.03 | $660.69 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $5,623.41
| Facility | | $56.23 | $1,479.11 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $4,570.88
| Professional | | $575.44 | $933.25 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $1,380.38
| Facility | | $50.12 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $831.76 / $1,698.24
| Professional | | $457.09 | $831.76 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $977.24 / $8,511.38
| Facility | | $302.00 | $977.24 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,230.27
| Professional | | $616.60 | $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
- $602.56 / $1,071.52 / $1,621.81
| Professional | | $602.56 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $5,623.41
| Facility | | $56.23 | $1,479.11 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $933.25 / $4,570.88
| Professional | | $588.84 | $933.25 | $4,570.88 |
- 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 / $912.01 / $1,737.80
| Professional | | $588.84 | $912.01 | $1,737.80 |