- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,238.72 / $3,801.89
| Facility | | $234.42 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $794.33
| Professional | | $181.97 | $295.12 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,311.31 / $19,498.45
| Facility | | $512.86 | $3,311.31 | $19,498.45 |
- 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
- $251.19 / $251.19 / $575.44
| Facility | | $251.19 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $1,023.29
| Professional | | $251.19 | $512.86 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $478.63 / $7,079.46
| Facility | | $223.87 | $478.63 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $741.31
| Professional | | $446.68 | $562.34 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $977.24
| Professional | | $263.03 | $457.09 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,548.13 / $19,498.45
| Facility | | $512.86 | $3,548.13 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $1,000.00
| Professional | | $213.80 | $389.05 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $457.09 / $1,000.00
| Professional | | $245.47 | $457.09 | $1,000.00 |