- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,047.13 / $3,311.31
| Facility | | $416.87 | $1,047.13 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $537.03
| Professional | | $416.87 | $416.87 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,089.30 / $2,137.96
| Facility | | $1,047.13 | $2,089.30 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $851.14
| Professional | | $257.04 | $371.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $1,000.00 / $4,073.80
| Facility | | $61.66 | $1,000.00 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $64.57 / $144.54
| Professional | | $47.86 | $64.57 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $602.56 / $1,380.38
| Facility | | $281.84 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $457.09 / $630.96
| Professional | | $416.87 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $724.44
| Professional | | $371.54 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $3,090.30
| Professional | | $2,089.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $1,023.29
| Facility | | $416.87 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $457.09 / $630.96
| Professional | | $416.87 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $6,309.57
| Professional | | $331.13 | $467.74 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $416.87 / $416.87
| Facility | | $173.78 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $186.21 / $912.01
| Professional | | $173.78 | $186.21 | $912.01 |