- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,388.44 / $5,623.41
| Facility | | $478.63 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $1,513.56
| Professional | | $416.87 | $489.78 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $5,370.32
| Facility | | $56.23 | $1,778.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $691.83 / $3,548.13
| Professional | | $380.19 | $691.83 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,479.11
| Professional | | $524.81 | $891.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $851.14 / $8,511.38
| Facility | | $302.00 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $977.24
| Professional | | $575.44 | $724.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $1,318.26
| Professional | | $512.86 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $5,370.32
| Facility | | $56.23 | $1,778.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $3,548.13
| Professional | | $380.19 | $676.08 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,513.56
| Professional | | $489.78 | $741.31 | $1,513.56 |