- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $5,623.41
| Facility | | $933.25 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $2,454.71
| Professional | | $831.76 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,137.96 / $5,888.44
| Facility | | $56.23 | $2,137.96 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,348.96 / $9,772.37
| Professional | | $776.25 | $1,348.96 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,412.54 / $2,344.23
| Professional | | $954.99 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,445.44 / $8,511.38
| Facility | | $302.00 | $1,445.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,202.26 / $1,659.59
| Professional | | $954.99 | $1,202.26 | $1,659.59 |
- 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
- $891.25 / $1,584.89 / $2,398.83
| Professional | | $891.25 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,187.76 / $5,888.44
| Facility | | $56.23 | $2,187.76 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,348.96 / $9,772.37
| Professional | | $776.25 | $1,348.96 | $9,772.37 |
- 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
- $870.96 / $1,318.26 / $2,630.27
| Professional | | $870.96 | $1,318.26 | $2,630.27 |