- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,388.44 / $5,623.41
| Facility | | $524.81 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $575.44 / $1,348.96
| Professional | | $467.74 | $575.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,659.59 / $4,786.30
| Facility | | $56.23 | $1,659.59 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $758.58 / $6,309.57
| Professional | | $436.52 | $758.58 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,348.96
| Professional | | $537.03 | $794.33 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,096.48 / $7,079.46
| Facility | | $512.86 | $1,096.48 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $977.24
| Professional | | $562.34 | $707.95 | $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
- $524.81 / $933.25 / $1,380.38
| Professional | | $524.81 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,737.80 / $4,786.30
| Facility | | $56.23 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $776.25 / $6,309.57
| Professional | | $436.52 | $776.25 | $6,309.57 |
- 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 |