- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,023.29
| Professional | | $707.95 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,818.38 / $2,818.38
| Facility | | $1,548.82 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,548.82 / $1,949.84
| Professional | | $831.76 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $7,413.10
| Facility | | $467.74 | $467.74 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $3,019.95
| Professional | | $467.74 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $416.87 / $1,445.44
| Facility | | $147.91 | $416.87 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,023.29 / $6,918.31
| Facility | | $91.20 | $1,023.29 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $1,148.15
| Professional | | $489.78 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $89.13 / $758.58
| Professional | | $53.70 | $89.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $389.05
| Professional | | $177.83 | $302.00 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,454.71 / $7,079.46
| Facility | | $467.74 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $467.74 / $467.74
| Professional | | $104.71 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $512.86 / $1,023.29
| Facility | | $61.66 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,230.27
| Professional | | $478.63 | $645.65 | $1,230.27 |