- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.23 / $2,618.00 / $3,693.00
| Facility | | $188.23 | $2,618.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.09 / $213.80 / $501.34
| Professional | | $141.09 | $213.80 | $501.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.99 / $2,854.00 / $9,039.00
| Facility | | $437.99 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.75 / $393.66 / $1,285.52
| Professional | | $197.75 | $393.66 | $1,285.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.79 / $276.63 / $488.14
| Facility | | $212.79 | $276.63 | $488.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.58 / $415.46 / $770.62
| Professional | | $220.58 | $415.46 | $770.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.55 / $388.00 / $6,679.00
| Facility | | $182.55 | $388.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.43 / $369.24 / $509.77
| Professional | | $291.43 | $369.24 | $509.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.82 / $471.71 / $778.55
| Professional | | $222.82 | $471.71 | $778.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.77 / $1,901.77 / $1,950.98
| Facility | | $1,901.77 | $1,901.77 | $1,950.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.01 / $515.01 / $515.01
| Professional | | $515.01 | $515.01 | $515.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.02 / $3,764.00 / $16,394.00
| Facility | | $904.02 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.03 / $477.70 / $1,874.88
| Professional | | $232.03 | $477.70 | $1,874.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.45 / $356.52 / $736.96
| Professional | | $209.45 | $356.52 | $736.96 |