- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.02 / $1,566.84 / $4,880.00
| Facility | | $596.02 | $1,566.84 | $4,880.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.38 / $518.25 / $837.94
| Professional | | $68.38 | $518.25 | $837.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.34 / $144.34 / $144.34
| Professional | | $144.34 | $144.34 | $144.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.23 / $365.43 / $1,334.58
| Professional | | $96.23 | $365.43 | $1,334.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $887.89 / $1,675.01
| Facility | | $323.44 | $887.89 | $1,675.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.50 / $240.00 / $1,245.68
| Professional | | $90.50 | $240.00 | $1,245.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.38 / $289.58 / $923.10
| Facility | | $68.38 | $289.58 | $923.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $739.16 / $1,495.40
| Professional | | $400.00 | $739.16 | $1,495.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.60 / $123.60 / $1,337.40
| Professional | | $103.60 | $123.60 | $1,337.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.27 / $680.80 / $1,409.93
| Professional | | $492.27 | $680.80 | $1,409.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,016.43 / $1,016.43
| Facility | | $55.00 | $1,016.43 | $1,016.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.89 / $3,994.47 / $4,701.53
| Professional | | $2,064.89 | $3,994.47 | $4,701.53 |