- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.00 / $2,079.00 / $3,625.00
| Facility | | $197.00 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $215.19 / $423.26
| Professional | | $129.47 | $215.19 | $423.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.54 / $1,251.81 / $7,161.00
| Facility | | $414.54 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.66 / $382.04 / $1,233.76
| Professional | | $186.66 | $382.04 | $1,233.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.33 / $260.43 / $459.56
| Facility | | $200.33 | $260.43 | $459.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.28 / $359.57 / $635.64
| Professional | | $228.28 | $359.57 | $635.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.92 / $346.54 / $707.25
| Professional | | $190.92 | $346.54 | $707.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.20 / $273.95 / $6,679.00
| Facility | | $169.20 | $273.95 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.39 / $355.79 / $491.13
| Professional | | $281.39 | $355.79 | $491.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.90 / $442.24 / $747.07
| Professional | | $208.90 | $442.24 | $747.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.76 / $2,022.88 / $5,979.11
| Facility | | $461.76 | $2,022.88 | $5,979.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.43 / $199.91 / $509.94
| Professional | | $199.43 | $199.91 | $509.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.66 / $2,078.00 / $11,500.00
| Facility | | $857.66 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.71 / $484.79 / $1,827.84
| Professional | | $254.71 | $484.79 | $1,827.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.46 / $355.50 / $692.78
| Professional | | $230.46 | $355.50 | $692.78 |