- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,122.02 / $1,122.02
| Facility | | $489.78 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $316.23 / $398.11
| Professional | | $120.23 | $316.23 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $66.07 / $1,202.26
| Professional | | $56.23 | $66.07 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,318.26 / $2,089.30
| Facility | | $1,122.02 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $1,258.93
| Professional | | $467.74 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,659.59 / $2,398.83
| Facility | | $407.38 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,691.53
| Professional | | $2,454.71 | $2,454.71 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,412.54
| Facility | | $323.59 | $489.78 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $2,041.74
| Professional | | $74.13 | $100.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $64.57 / $407.38
| Professional | | $50.12 | $64.57 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $954.99 / $1,348.96
| Professional | | $316.23 | $954.99 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,949.84 / $1,949.84
| Facility | | $812.83 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,621.81 / $2,041.74
| Professional | | $588.84 | $1,621.81 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Professional | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,238.72 / $3,090.30
| Professional | | $1,174.90 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $489.78
| Facility | | $131.83 | $131.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $100.00 / $407.38
| Professional | | $72.44 | $100.00 | $407.38 |