- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.38 / $1,886.00 / $3,625.00
| Facility | | $409.38 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.67 / $260.39 / $1,049.44
| Professional | | $69.67 | $260.39 | $1,049.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.94 / $818.35 / $2,733.00
| Facility | | $195.94 | $818.35 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.67 / $1,060.20 / $2,694.82
| Professional | | $97.67 | $1,060.20 | $2,694.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.39 / $130.51 / $255.99
| Facility | | $100.39 | $130.51 | $255.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.38 / $200.38 / $1,411.71
| Professional | | $200.38 | $200.38 | $1,411.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.10 / $860.57 / $2,194.31
| Professional | | $156.10 | $860.57 | $2,194.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.37 / $300.00 / $6,679.00
| Facility | | $88.37 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.19 / $838.27 / $1,496.05
| Professional | | $662.19 | $838.27 | $1,496.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.83 / $358.99 / $1,535.99
| Professional | | $110.83 | $358.99 | $1,535.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.45 / $196.45 / $413.72
| Facility | | $196.45 | $196.45 | $413.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.75 / $1,630.00 / $4,057.92
| Professional | | $902.75 | $1,630.00 | $4,057.92 |
- 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
- $893.20 / $1,233.34 / $2,191.52
| Professional | | $893.20 | $1,233.34 | $2,191.52 |