- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.20 / $1,857.50 / $3,469.00
| Facility | | $302.20 | $1,857.50 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.58 / $234.74 / $549.63
| Professional | | $197.58 | $234.74 | $549.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.03 / $2,826.85 / $9,039.00
| Facility | | $496.03 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.65 / $459.25 / $2,441.19
| Professional | | $216.65 | $459.25 | $2,441.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.36 / $324.27 / $578.91
| Facility | | $252.36 | $324.27 | $578.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.55 / $432.57 / $626.36
| Professional | | $301.55 | $432.57 | $626.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.63 / $379.27 / $664.29
| Professional | | $234.63 | $379.27 | $664.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.93 / $322.10 / $6,679.00
| Facility | | $212.93 | $322.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.87 / $331.75 / $456.03
| Professional | | $273.87 | $331.75 | $456.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.73 / $538.11 / $709.82
| Professional | | $261.73 | $538.11 | $709.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,436.96 / $4,436.96 / $4,436.96
| Facility | | $4,436.96 | $4,436.96 | $4,436.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.52 / $3,764.00 / $11,500.00
| Facility | | $1,083.52 | $3,764.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.11 / $531.39 / $2,441.19
| Professional | | $257.11 | $531.39 | $2,441.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.02 / $401.27 / $984.62
| Professional | | $250.02 | $401.27 | $984.62 |