- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,445.44 / $2,290.87
| Facility | | $645.65 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $851.14
| Professional | | $457.09 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,258.93
| Professional | | $851.14 | $851.14 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,202.26 / $2,818.38
| Facility | | $489.78 | $1,202.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $3,630.78 / $3,630.78
| Professional | | $758.58 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $2,951.21
| Facility | | $758.58 | $1,258.93 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,479.11
| Professional | | $794.33 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $1,348.96
| Professional | | $645.65 | $758.58 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $50,118.72
| Facility | | $977.24 | $1,445.44 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $776.25
| Professional | | $758.58 | $758.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $758.58 / $912.01
| Facility | | $691.83 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $1,000.00
| Professional | | $316.23 | $457.09 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $870.96
| Facility | | $645.65 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $1,513.56
| Professional | | $512.86 | $758.58 | $1,513.56 |