- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $2,818.38
| Facility | | $371.54 | $371.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $2,137.96
| Professional | | $371.54 | $588.84 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,698.24 / $5,754.40
| Facility | | $741.31 | $1,698.24 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $741.31 / $4,168.69
| Professional | | $245.47 | $741.31 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $1,778.28
| Facility | | $588.84 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,348.96 / $2,398.83
| Facility | | $371.54 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $954.99 / $2,041.74
| Professional | | $275.42 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,071.52 / $7,079.46
| Facility | | $158.49 | $1,071.52 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $933.25 / $1,479.11
| Professional | | $114.82 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,949.84
| Professional | | $758.58 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,698.24 / $5,754.40
| Facility | | $741.31 | $1,698.24 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $741.31 / $4,168.69
| Professional | | $245.47 | $741.31 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $1,000.00 / $1,819.70
| Facility | | $141.25 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $870.96 / $1,995.26
| Professional | | $251.19 | $870.96 | $1,995.26 |