- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $645.65 / $2,137.96
| Facility | | $281.84 | $645.65 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $467.74
| Professional | | $281.84 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $512.86 / $2,290.87
| Facility | | $61.66 | $512.86 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $660.69
| Professional | | $323.59 | $478.63 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $851.14 / $2,041.74
| Facility | | $302.00 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $562.34 / $676.08
| Professional | | $223.87 | $562.34 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,467.37 / $3,467.37
| Professional | | $2,344.23 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $870.96
| Facility | | $354.81 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $588.84
| Professional | | $281.84 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $501.19 / $1,000.00
| Professional | | $457.09 | $501.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $489.78 / $1,380.38
| Facility | | $331.13 | $489.78 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $489.78 / $812.83
| Professional | | $223.87 | $489.78 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $467.74
| Facility | | $165.96 | $194.98 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $323.59
| Professional | | $194.98 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $467.74 / $467.74
| Professional | | $181.97 | $467.74 | $467.74 |