- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.10 / $1,248.55 / $6,042.40
| Facility | | $382.10 | $1,248.55 | $6,042.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.35 / $332.03 / $1,187.42
| Professional | | $236.35 | $332.03 | $1,187.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,193.00 / $5,962.00
| Facility | | $1,905.00 | $3,193.00 | $5,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.54 / $697.63 / $1,856.83
| Professional | | $293.54 | $697.63 | $1,856.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.74 / $1,067.77 / $1,637.99
| Facility | | $913.74 | $1,067.77 | $1,637.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.91 / $712.10 / $1,415.51
| Professional | | $321.91 | $712.10 | $1,415.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.35 / $359.69 / $653.60
| Facility | | $236.35 | $359.69 | $653.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.77 / $376.14 / $3,036.00
| Facility | | $236.77 | $376.14 | $3,036.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.38 / $1,127.03 / $2,523.76
| Professional | | $345.38 | $1,127.03 | $2,523.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $303.31 / $713.85
| Professional | | $50.00 | $303.31 | $713.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.35 / $359.69 / $653.60
| Facility | | $236.35 | $359.69 | $653.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.28 / $783.39 / $1,153.77
| Professional | | $519.28 | $783.39 | $1,153.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.68 / $1,721.10 / $7,909.30
| Facility | | $406.68 | $1,721.10 | $7,909.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.85 / $1,448.10 / $2,523.76
| Professional | | $362.85 | $1,448.10 | $2,523.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.88 / $1,235.59 / $1,728.36
| Professional | | $909.88 | $1,235.59 | $1,728.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.00 / $3,628.00 / $5,471.00
| Facility | | $2,781.00 | $3,628.00 | $5,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.84 / $713.35 / $1,469.86
| Professional | | $334.84 | $713.35 | $1,469.86 |