- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.82 / $2,581.76 / $3,469.00
| Facility | | $308.82 | $2,581.76 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.83 / $308.82 / $454.94
| Professional | | $272.83 | $308.82 | $454.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.00 / $3,245.00 / $16,394.00
| Facility | | $649.00 | $3,245.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.76 / $551.52 / $2,054.26
| Professional | | $285.76 | $551.52 | $2,054.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $2,140.21 / $2,140.21
| Professional | | $605.88 | $2,140.21 | $2,140.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $7,058.84
| Facility | | $593.00 | $652.29 | $7,058.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.50 / $489.17 / $942.50
| Professional | | $310.50 | $489.17 | $942.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.31 / $563.32 / $6,679.00
| Facility | | $273.31 | $563.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.47 / $388.53 / $694.66
| Professional | | $307.47 | $388.53 | $694.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.51 / $666.24 / $840.60
| Professional | | $337.51 | $666.24 | $840.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.25 / $5,572.00 / $17,986.75
| Facility | | $1,266.25 | $5,572.00 | $17,986.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.06 / $563.32 / $2,054.26
| Professional | | $308.06 | $563.32 | $2,054.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.50 / $468.90 / $987.46
| Professional | | $304.50 | $468.90 | $987.46 |