- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.18 / $1,844.67 / $2,503.21
| Facility | | $420.18 | $1,844.67 | $2,503.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.82 / $1,844.67 / $1,844.67
| Professional | | $136.82 | $1,844.67 | $1,844.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.08 / $297.61 / $941.10
| Facility | | $99.08 | $297.61 | $941.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.36 / $2,170.19 / $3,742.91
| Professional | | $94.36 | $2,170.19 | $3,742.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,863.69 / $4,904.76 / $9,034.33
| Facility | | $2,863.69 | $4,904.76 | $9,034.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.26 / $143.26 / $143.26
| Facility | | $143.26 | $143.26 | $143.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.26 / $143.26 / $143.26
| Professional | | $143.26 | $143.26 | $143.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.36 / $149.09 / $8,090.00
| Facility | | $94.36 | $149.09 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.28 / $132.10 / $191.21
| Professional | | $108.28 | $132.10 | $191.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.67 / $1,844.67 / $2,975.45
| Professional | | $1,844.67 | $1,844.67 | $2,975.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.67 / $1,844.67 / $2,170.19
| Facility | | $1,844.67 | $1,844.67 | $2,170.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.67 / $2,170.19 / $3,742.91
| Professional | | $1,844.67 | $2,170.19 | $3,742.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.67 / $2,170.19 / $3,680.05
| Professional | | $1,844.67 | $2,170.19 | $3,680.05 |