- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,090.30 / $5,128.61
| Facility | | $630.96 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,621.81
| Professional | | $446.68 | $660.69 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,897.79 / $45,708.82
| Facility | | $1,096.48 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $812.83 / $2,089.30
| Professional | | $446.68 | $812.83 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,318.26
| Facility | | $575.44 | $575.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $1,698.24
| Professional | | $575.44 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $870.96 / $1,621.81
| Professional | | $446.68 | $870.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,000.00 / $7,079.46
| Facility | | $467.74 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,318.26
| Professional | | $758.58 | $954.99 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $954.99 / $1,737.80
| Professional | | $562.34 | $954.99 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $758.58
| Professional | | $165.96 | $165.96 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,897.79 / $45,708.82
| Facility | | $1,148.15 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $2,089.30
| Professional | | $457.09 | $812.83 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $851.14 / $1,778.28
| Professional | | $467.74 | $851.14 | $1,778.28 |