- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,691.53 / $3,715.35
| Facility | | $467.74 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $467.74 / $1,000.00
| Professional | | $229.09 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,344.23 / $28,840.32
| Facility | | $489.78 | $2,344.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $549.54 / $3,467.37
| Professional | | $239.88 | $549.54 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $758.58
| Facility | | $331.13 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $1,071.52
| Professional | | $331.13 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,122.02 / $1,995.26
| Facility | | $588.84 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $501.19 / $1,122.02
| Professional | | $251.19 | $501.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $501.19 / $7,079.46
| Facility | | $208.93 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,148.15
| Professional | | $588.84 | $812.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $549.54 / $1,380.38
| Professional | | $245.47 | $549.54 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,344.23 / $4,365.16
| Facility | | $977.24 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $870.96
| Professional | | $363.08 | $645.65 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,344.23 / $28,840.32
| Facility | | $489.78 | $2,344.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $549.54 / $3,467.37
| Professional | | $239.88 | $549.54 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | | $676.08 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $537.03 / $1,258.93
| Professional | | $245.47 | $537.03 | $1,258.93 |