- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,754.23 / $4,897.79
| Facility | | $275.42 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $323.59 / $851.14
| Professional | | $181.97 | $323.59 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,659.59 / $28,840.32
| Facility | | $501.19 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $436.52 / $1,122.02
| Professional | | $213.80 | $436.52 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $588.84
| Facility | | $251.19 | $251.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $549.54 / $1,000.00
| Professional | | $251.19 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $478.63 / $954.99
| Professional | | $257.04 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $501.19 / $7,079.46
| Facility | | $194.98 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $758.58
| Professional | | $416.87 | $537.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $467.74 / $1,000.00
| Professional | | $229.09 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,659.59 / $28,840.32
| Facility | | $501.19 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $1,148.15
| Professional | | $218.78 | $436.52 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $416.87 / $870.96
| Professional | | $223.87 | $416.87 | $870.96 |