- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.20 / $2,618.00 / $3,625.00
| Facility | | $269.20 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.95 / $301.11 / $933.11
| Professional | | $186.95 | $301.11 | $933.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.05 / $1,052.09 / $3,445.00
| Facility | | $550.05 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.63 / $521.25 / $1,673.36
| Professional | | $254.63 | $521.25 | $1,673.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.25 / $353.93 / $624.54
| Facility | | $272.25 | $353.93 | $624.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.44 / $592.33 / $886.40
| Professional | | $369.44 | $592.33 | $886.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.12 / $552.00 / $1,094.97
| Professional | | $292.12 | $552.00 | $1,094.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.41 / $496.42 / $6,679.00
| Facility | | $234.41 | $496.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.98 / $496.15 / $684.89
| Professional | | $391.98 | $496.15 | $684.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.85 / $600.91 / $965.05
| Professional | | $283.85 | $600.91 | $965.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,103.39 / $5,103.39 / $5,103.39
| Facility | | $5,103.39 | $5,103.39 | $5,103.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.00 / $266.00 / $732.44
| Professional | | $266.00 | $266.00 | $732.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.14 / $661.12 / $2,541.84
| Professional | | $343.14 | $661.12 | $2,541.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.85 / $498.10 / $969.72
| Professional | | $283.85 | $498.10 | $969.72 |