- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,000.00 / $1,000.00
| Facility | | $436.52 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $436.52
| Professional | | $251.19 | $295.12 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $1,348.96
| Professional | | $173.78 | $204.17 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,862.09
| Facility | | $1,000.00 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,000.00 / $1,122.02
| Professional | | $416.87 | $1,000.00 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,513.56 / $2,290.87
| Facility | | $371.54 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,398.83
| Professional | | $2,187.76 | $2,187.76 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $1,258.93
| Facility | | $302.00 | $436.52 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $1,819.70
| Professional | | $162.18 | $218.78 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $181.97
| Professional | | $50.12 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,202.26
| Professional | | $588.84 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,698.24 / $1,698.24
| Facility | | $724.44 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,819.70 / $1,819.70
| Professional | | $524.81 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $436.52
| Facility | | $288.40 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $602.56
| Professional | | $151.36 | $218.78 | $602.56 |