- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,000.00 / $1,819.70
| Facility | | $407.38 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $1,819.70
| Professional | | $181.97 | $234.42 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $645.65 / $1,380.38
| Facility | | $128.82 | $645.65 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $630.96
| Professional | | $245.47 | $288.40 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $588.84 / $776.25
| Facility | | $100.00 | $588.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $549.54
| Professional | | $162.18 | $213.80 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $467.74 / $977.24
| Facility | | $186.21 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $186.21 / $630.96
| Professional | | $141.25 | $186.21 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $371.54
| Professional | | $218.78 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $478.63
| Professional | | $245.47 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,041.74
| Professional | | $1,380.38 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $812.83
| Facility | | $218.78 | $331.13 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $562.34
| Professional | | $147.91 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $3,311.31
| Professional | | $218.78 | $275.42 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $275.42 / $275.42
| Facility | | $114.82 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $524.81
| Professional | | $114.82 | $114.82 | $524.81 |