- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $512.86
| Professional | | $181.97 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,000.00 / $2,818.38
| Facility | | $208.93 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $354.81 / $1,288.25
| Professional | | $181.97 | $354.81 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $199.53
| Facility | | $128.82 | $147.91 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $114.82 / $52,480.75
| Facility | | $64.57 | $114.82 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $407.38 / $676.08
| Professional | | $208.93 | $407.38 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $93.33 / $7,079.46
| Facility | | $53.70 | $93.33 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $125.89 / $309.03
| Professional | | $40.74 | $125.89 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $354.81 / $549.54
| Professional | | $194.98 | $354.81 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,000.00 / $2,818.38
| Facility | | $208.93 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $354.81 / $1,288.25
| Professional | | $186.21 | $354.81 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $588.84
| Professional | | $213.80 | $389.05 | $588.84 |