- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,691.53 / $4,897.79
| Facility | | $257.04 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $831.76
| Professional | | $177.83 | $288.40 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,659.59 / $28,840.32
| Facility | | $467.74 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $1,000.00
| Professional | | $218.78 | $389.05 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $537.03
| Facility | | $234.42 | $234.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $524.81 / $933.25
| Professional | | $269.15 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $467.74 / $870.96
| Professional | | $239.88 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $501.19 / $7,079.46
| Facility | | $177.83 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $660.69
| Professional | | $363.08 | $467.74 | $660.69 |
- 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
- $208.93 / $407.38 / $870.96
| Professional | | $208.93 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,659.59 / $28,840.32
| Facility | | $489.78 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $1,023.29
| Professional | | $218.78 | $389.05 | $1,023.29 |
- 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
- $213.80 / $398.11 / $776.25
| Professional | | $213.80 | $398.11 | $776.25 |