- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.14 / $2,618.00 / $3,625.00
| Facility | | $396.14 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.44 / $396.14 / $662.34
| Professional | | $167.44 | $396.14 | $662.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.68 / $1,339.09 / $4,390.91
| Facility | | $352.68 | $1,339.09 | $4,390.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.37 / $591.61 / $3,466.41
| Professional | | $182.37 | $591.61 | $3,466.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.08 / $240.60 / $471.95
| Facility | | $185.08 | $240.60 | $471.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.36 / $546.41 / $1,235.35
| Professional | | $240.36 | $546.41 | $1,235.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.66 / $337.48 / $6,679.00
| Facility | | $161.66 | $337.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.68 / $426.91 / $654.34
| Professional | | $221.68 | $426.91 | $654.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.21 / $439.12 / $951.18
| Professional | | $203.21 | $439.12 | $951.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.81 / $1,718.81 / $1,718.81
| Facility | | $1,718.81 | $1,718.81 | $1,718.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.32 / $1,046.10 / $3,466.41
| Professional | | $470.32 | $1,046.10 | $3,466.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,510.00 / $6,313.75
| Facility | | $1,106.00 | $2,510.00 | $6,313.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.51 / $664.13 / $1,395.67
| Professional | | $447.51 | $664.13 | $1,395.67 |