- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,235.94 / $5,495.41
| Facility | | $302.00 | $3,235.94 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $288.40 / $831.76
| Professional | | $162.18 | $288.40 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,454.71 / $4,265.80
| Facility | | $602.56 | $2,454.71 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $776.25 / $954.99
| Professional | | $302.00 | $776.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $331.13 / $1,071.52
| Professional | | $199.53 | $331.13 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,019.95 / $6,025.60
| Facility | | $263.03 | $3,019.95 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $331.13 / $954.99
| Professional | | $177.83 | $331.13 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $5,248.07
| Facility | | $2,754.23 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $831.76
| Professional | | $223.87 | $316.23 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $3,890.45
| Professional | | $288.40 | $446.68 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $1,096.48
| Professional | | $186.21 | $501.19 | $1,096.48 |