- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,230.27 / $2,089.30
| Facility | | $416.87 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $245.47 / $331.13
| Professional | | $194.98 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $1,513.56
| Facility | | $758.58 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $144.54 / $245.47
| Professional | | $120.23 | $144.54 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $707.95 / $2,884.03
| Facility | | $69.18 | $707.95 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $229.09 / $501.19
| Professional | | $177.83 | $229.09 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $398.11 / $1,000.00
| Facility | | $199.53 | $398.11 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $331.13 / $457.09
| Professional | | $302.00 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $331.13 / $524.81
| Professional | | $269.15 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $2,238.72
| Professional | | $1,513.56 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $794.33
| Facility | | $229.09 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $331.13 / $331.13
| Professional | | $302.00 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $4,570.88
| Professional | | $239.88 | $338.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $302.00 / $302.00
| Facility | | $125.89 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $575.44
| Professional | | $125.89 | $125.89 | $575.44 |