- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.01 / $529.44 / $2,452.69
| Facility | | $243.01 | $529.44 | $2,452.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.50 / $1,754.16 / $2,858.58
| Professional | | $384.50 | $1,754.16 | $2,858.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.89 / $877.37 / $3,424.05
| Professional | | $701.89 | $877.37 | $3,424.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.85 / $55.85 / $3,915.47
| Facility | | $55.85 | $55.85 | $3,915.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.85 / $3,915.47 / $3,971.32
| Professional | | $55.85 | $3,915.47 | $3,971.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.00 / $774.96 / $2,496.71
| Facility | | $474.00 | $774.96 | $2,496.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.41 / $371.97 / $837.99
| Professional | | $201.41 | $371.97 | $837.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.70 / $332.00 / $794.52
| Facility | | $247.70 | $332.00 | $794.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.43 / $385.33 / $683.59
| Professional | | $285.43 | $385.33 | $683.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.50 / $50.50 / $50.50
| Facility | | $50.50 | $50.50 | $50.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.45 / $352.09 / $631.01
| Professional | | $231.45 | $352.09 | $631.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.32 / $767.00 / $2,496.71
| Facility | | $285.32 | $767.00 | $2,496.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.78 / $379.12 / $2,198.28
| Professional | | $196.78 | $379.12 | $2,198.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.06 / $1,687.94 / $4,906.52
| Professional | | $341.06 | $1,687.94 | $4,906.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.27 / $346.27 / $871.32
| Facility | | $346.27 | $346.27 | $871.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.30 / $453.41 / $788.20
| Professional | | $243.30 | $453.41 | $788.20 |