- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,818.38 / $4,897.79
| Facility | | $588.84 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $933.25 / $2,884.03
| Professional | | $588.84 | $933.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $45,708.82
| Facility | | $1,584.89 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $2,290.87
| Professional | | $588.84 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,819.70
| Facility | | $794.33 | $794.33 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,089.30
| Professional | | $933.25 | $1,412.54 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,047.13 / $2,187.76
| Professional | | $691.83 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,258.93 / $7,079.46
| Facility | | $575.44 | $1,258.93 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $1,513.56
| Professional | | $812.83 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,122.02 / $2,041.74
| Professional | | $691.83 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,073.80 / $4,786.30
| Facility | | $3,715.35 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,202.26 / $1,288.25
| Professional | | $1,174.90 | $1,202.26 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $45,708.82
| Facility | | $1,584.89 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $2,290.87
| Professional | | $588.84 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $1,949.84
| Professional | | $676.08 | $1,000.00 | $1,949.84 |