- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.68 / $2,581.76 / $3,625.00
| Facility | | $257.68 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.38 / $280.16 / $563.16
| Professional | | $179.38 | $280.16 | $563.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.39 / $2,376.00 / $8,498.00
| Facility | | $578.39 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.00 / $516.16 / $1,721.28
| Professional | | $259.00 | $516.16 | $1,721.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.26 / $361.74 / $638.33
| Facility | | $278.26 | $361.74 | $638.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.57 / $555.41 / $879.85
| Professional | | $362.57 | $555.41 | $879.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.77 / $460.89 / $972.13
| Professional | | $265.77 | $460.89 | $972.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.58 / $507.38 / $6,679.00
| Facility | | $240.58 | $507.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.26 / $470.08 / $648.89
| Professional | | $373.26 | $470.08 | $648.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.86 / $619.98 / $996.09
| Professional | | $292.86 | $619.98 | $996.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.54 / $3,372.00 / $16,394.00
| Facility | | $1,626.54 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.68 / $639.75 / $2,429.92
| Professional | | $342.68 | $639.75 | $2,429.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.20 / $482.87 / $969.78
| Professional | | $270.20 | $482.87 | $969.78 |