- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,818.38 / $5,623.41
| Facility | | $208.93 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $1,000.00
| Professional | | $158.49 | $288.40 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,548.13 / $28,840.32
| Facility | | $446.68 | $3,548.13 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $776.25
| Professional | | $194.98 | $323.59 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $489.78
| Facility | | $218.78 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $446.68
| Professional | | $208.93 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $691.83
| Professional | | $223.87 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $7,079.46
| Facility | | $173.78 | $295.12 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $537.03
| Professional | | $288.40 | $371.54 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $707.95
| Professional | | $208.93 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $3,890.45
| Facility | | $741.31 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,548.13 / $28,840.32
| Facility | | $446.68 | $3,548.13 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $794.33
| Professional | | $194.98 | $323.59 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $645.65
| Professional | | $199.53 | $346.74 | $645.65 |