- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.12 / $718.09 / $1,974.00
| Facility | | $206.12 | $718.09 | $1,974.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.78 / $228.11 / $233.61
| Professional | | $149.78 | $228.11 | $233.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $1,376.90
| Facility | | $244.00 | $614.00 | $1,376.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.69 / $254.07 / $363.95
| Professional | | $214.69 | $254.07 | $363.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $362.78 / $2,465.21
| Facility | | $59.30 | $362.78 | $2,465.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.05 / $178.64 / $446.69
| Professional | | $125.05 | $178.64 | $446.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.32 / $460.89 / $920.00
| Facility | | $181.32 | $460.89 | $920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $274.83 / $371.02
| Professional | | $219.86 | $274.83 | $371.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.35 / $316.05 / $524.92
| Professional | | $247.35 | $316.05 | $524.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.20 / $1,305.44 / $1,305.44
| Facility | | $478.20 | $1,305.44 | $1,305.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.65 / $1,368.65 / $2,061.23
| Professional | | $1,368.65 | $1,368.65 | $2,061.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.86 / $329.80 / $729.21
| Facility | | $219.86 | $329.80 | $729.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $302.31 / $412.25
| Professional | | $274.83 | $302.31 | $412.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $247.35 / $373.76
| Professional | | $219.86 | $247.35 | $373.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $123.67 / $546.03
| Professional | | $115.43 | $123.67 | $546.03 |