- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.00 / $4,457.00 / $12,075.00
| Facility | | $1,508.00 | $4,457.00 | $12,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.57 / $315.83 / $315.83
| Professional | | $139.57 | $315.83 | $315.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,278.00 / $12,915.00
| Facility | | $4,100.00 | $7,278.00 | $12,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.43 / $86.58 / $164.05
| Professional | | $69.43 | $86.58 | $164.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.99 / $262.99 / $7,227.90
| Facility | | $262.99 | $262.99 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.47 / $1,030.56 / $1,030.56
| Professional | | $236.47 | $1,030.56 | $1,030.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $332.00 / $596.14
| Facility | | $250.00 | $332.00 | $596.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.59 / $289.58 / $465.49
| Professional | | $167.59 | $289.58 | $465.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.78 / $294.14 / $450.01
| Professional | | $203.78 | $294.14 | $450.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.99 / $555.00 / $7,227.90
| Facility | | $262.99 | $555.00 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.47 / $1,030.56 / $1,030.56
| Professional | | $236.47 | $1,030.56 | $1,030.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $6,450.00 / $12,742.00
| Facility | | $2,337.00 | $6,450.00 | $12,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.24 / $316.93 / $665.29
| Professional | | $225.24 | $316.93 | $665.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.51 / $214.51 / $214.72
| Facility | | $214.51 | $214.51 | $214.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.51 / $214.72 / $450.01
| Professional | | $214.51 | $214.72 | $450.01 |