- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,388.44 / $5,623.41
| Facility | | $263.03 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $1,698.24
| Professional | | $263.03 | $489.78 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $4,073.80
| Facility | | $56.23 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $630.96 / $13,182.57
| Professional | | $302.00 | $630.96 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,412.54
| Professional | | $501.19 | $831.76 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $588.84 / $8,511.38
| Facility | | $302.00 | $588.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $933.25
| Professional | | $416.87 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $1,000.00
| Professional | | $380.19 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,778.28 / $4,073.80
| Facility | | $56.23 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $630.96 / $13,182.57
| Professional | | $302.00 | $630.96 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,230.27
| Professional | | $457.09 | $676.08 | $1,230.27 |