- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $2,089.30 / $3,715.35
| Facility | | $112.20 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $100.00 / $281.84
| Professional | | $51.29 | $100.00 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,548.13
| Facility | | $56.23 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $117.49 / $707.95
| Professional | | $57.54 | $117.49 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $144.54
| Facility | | $63.10 | $63.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $141.25 / $257.04
| Professional | | $74.13 | $141.25 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $199.53 / $501.19
| Facility | | $112.20 | $199.53 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $128.82 / $302.00
| Professional | | $63.10 | $128.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $177.83 / $7,079.46
| Facility | | $56.23 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $151.36 / $218.78
| Professional | | $102.33 | $151.36 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $7,079.46
| Facility | | $346.74 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $114.82 / $239.88
| Professional | | $57.54 | $114.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,122.02 / $1,621.81
| Facility | | $407.38 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,548.13
| Facility | | $56.23 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $117.49 / $707.95
| Professional | | $57.54 | $117.49 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,949.84 / $5,623.41
| Facility | | $467.74 | $1,949.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $114.82 / $239.88
| Professional | | $57.54 | $114.82 | $239.88 |