- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,818.38 / $4,897.79
| Facility | | $323.59 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $1,023.29
| Professional | | $229.09 | $398.11 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,659.59 / $45,708.82
| Facility | | $630.96 | $1,659.59 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,230.27
| Professional | | $302.00 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $741.31
| Facility | | $323.59 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $1,148.15
| Professional | | $416.87 | $707.95 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,071.52
| Professional | | $338.84 | $602.56 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $575.44 / $7,079.46
| Facility | | $239.88 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $831.76
| Professional | | $446.68 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $1,071.52
| Professional | | $281.84 | $501.19 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $331.13
| Professional | | $323.59 | $323.59 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $45,708.82
| Facility | | $660.69 | $1,659.59 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,258.93
| Professional | | $302.00 | $501.19 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,000.00
| Professional | | $302.00 | $501.19 | $1,000.00 |