- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,747.00 / $5,454.00
| Facility | | $580.00 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.65 / $580.00 / $1,376.18
| Professional | | $104.65 | $580.00 | $1,376.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.33 / $953.00 / $4,050.00
| Facility | | $220.33 | $953.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.24 / $318.86 / $5,406.44
| Professional | | $175.24 | $318.86 | $5,406.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.49 / $431.57 / $573.54
| Professional | | $307.49 | $431.57 | $573.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.29 / $463.88 / $1,082.33
| Professional | | $301.29 | $463.88 | $1,082.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.30 / $316.47 / $8,090.00
| Facility | | $200.30 | $316.47 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.18 / $229.84 / $352.53
| Professional | | $119.18 | $229.84 | $352.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.97 / $539.15 / $684.55
| Professional | | $271.97 | $539.15 | $684.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.20 / $300.20 / $326.55
| Professional | | $300.20 | $300.20 | $326.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $5,876.00
| Facility | | $55.00 | $2,078.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.25 / $353.01 / $5,406.44
| Professional | | $193.25 | $353.01 | $5,406.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.43 / $306.45 / $677.37
| Professional | | $186.43 | $306.45 | $677.37 |