- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,754.23 / $4,897.79
| Facility | | $562.34 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $4,897.79
| Professional | | $269.15 | $562.34 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $7,079.46
| Facility | | $56.23 | $1,096.48 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $812.83 / $7,585.78
| Professional | | $288.40 | $812.83 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $707.95
| Facility | | $309.03 | $309.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $977.24 / $5,011.87
| Professional | | $309.03 | $977.24 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $1,412.54
| Facility | | $676.08 | $741.31 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $691.83 / $6,165.95
| Professional | | $295.12 | $691.83 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $398.11 / $8,511.38
| Facility | | $239.88 | $398.11 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,073.80 / $5,754.40
| Professional | | $2,951.21 | $4,073.80 | $5,754.40 |
- 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
- $288.40 / $1,318.26 / $6,606.93
| Professional | | $288.40 | $1,318.26 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,238.72 / $2,398.83
| Facility | | $1,122.02 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $1,000.00
| Professional | | $549.54 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $7,079.46
| Facility | | $56.23 | $1,096.48 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $812.83 / $7,585.78
| Professional | | $288.40 | $812.83 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,019.95 / $8,511.38
| Facility | | $707.95 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $741.31 / $6,309.57
| Professional | | $288.40 | $741.31 | $6,309.57 |