- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,000.00 / $1,659.59
| Facility | | $346.74 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $309.03 / $398.11
| Professional | | $147.91 | $309.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,041.74 / $2,089.30
| Facility | | $1,023.29 | $2,041.74 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $281.84 / $575.44
| Professional | | $114.82 | $281.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $588.84 / $2,398.83
| Facility | | $61.66 | $588.84 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $812.83
| Professional | | $239.88 | $316.23 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $676.08 / $1,445.44
| Facility | | $194.98 | $676.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $549.54
| Professional | | $323.59 | $446.68 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $707.95
| Professional | | $363.08 | $446.68 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,090.30 / $3,090.30
| Professional | | $2,041.74 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $1,071.52
| Facility | | $263.03 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $446.68 / $588.84
| Professional | | $407.38 | $446.68 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $4,897.79
| Professional | | $323.59 | $407.38 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $407.38 / $407.38
| Facility | | $169.82 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $112.20 / $489.78
| Professional | | $104.71 | $112.20 | $489.78 |