- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,148.15 / $1,905.46
| Facility | | $346.74 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $229.09 / $316.23
| Professional | | $181.97 | $229.09 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $1,445.44
| Facility | | $707.95 | $1,412.54 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $446.68
| Professional | | $158.49 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $660.69 / $2,754.23
| Facility | | $69.18 | $660.69 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $218.78 / $562.34
| Professional | | $165.96 | $218.78 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $478.63 / $1,000.00
| Facility | | $186.21 | $478.63 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $380.19
| Professional | | $223.87 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $489.78
| Professional | | $257.04 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,137.96 / $2,137.96
| Professional | | $1,412.54 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $741.31
| Facility | | $218.78 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $309.03 / $407.38
| Professional | | $281.84 | $309.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $3,388.44
| Professional | | $223.87 | $281.84 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $281.84
| Facility | | $117.49 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $549.54
| Professional | | $117.49 | $117.49 | $549.54 |