- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.11 / $2,663.12 / $3,693.00
| Facility | | $210.11 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.12 / $239.24 / $621.14
| Professional | | $148.12 | $239.24 | $621.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.95 / $2,376.00 / $8,498.00
| Facility | | $448.95 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.77 / $408.26 / $1,335.36
| Professional | | $201.77 | $408.26 | $1,335.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.44 / $281.37 / $496.51
| Facility | | $216.44 | $281.37 | $496.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.35 / $290.68 / $445.18
| Professional | | $201.35 | $290.68 | $445.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.31 / $425.70 / $839.30
| Professional | | $232.31 | $425.70 | $839.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.23 / $296.00 / $6,679.00
| Facility | | $183.23 | $296.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.49 / $370.07 / $510.84
| Professional | | $293.49 | $370.07 | $510.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.33 / $481.26 / $782.49
| Professional | | $227.33 | $481.26 | $782.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.11 / $1,718.81 / $3,863.50
| Facility | | $740.11 | $1,718.81 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.70 / $555.70 / $1,264.60
| Professional | | $555.70 | $555.70 | $1,264.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.97 / $3,372.00 / $16,394.00
| Facility | | $923.97 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.39 / $518.07 / $1,908.00
| Professional | | $286.39 | $518.07 | $1,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.77 / $389.28 / $913.07
| Professional | | $245.77 | $389.28 | $913.07 |