- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,625.00
| Facility | | $1,485.00 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.90 / $214.13 / $337.06
| Professional | | $135.90 | $214.13 | $337.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.61 / $3,715.00 / $9,039.00
| Facility | | $324.61 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.06 / $303.68 / $1,743.17
| Professional | | $150.06 | $303.68 | $1,743.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.31 / $268.95 / $357.44
| Professional | | $205.31 | $268.95 | $357.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.59 / $263.48 / $427.47
| Professional | | $178.59 | $263.48 | $427.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.69 / $300.00 / $6,679.00
| Facility | | $140.69 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.29 / $190.70 / $258.17
| Professional | | $158.29 | $190.70 | $258.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.03 / $341.03 / $449.88
| Professional | | $172.03 | $341.03 | $449.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.53 / $3,025.53 / $5,902.12
| Facility | | $3,025.53 | $3,025.53 | $5,902.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.65 / $108.92 / $120.58
| Professional | | $65.65 | $108.92 | $120.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,997.00 / $16,394.00
| Facility | | $1,061.00 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.27 / $333.95 / $1,743.17
| Professional | | $182.27 | $333.95 | $1,743.17 |
- 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
- $172.03 / $293.38 / $494.36
| Professional | | $172.03 | $293.38 | $494.36 |