- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.48 / $2,663.12 / $4,410.00
| Facility | | $194.48 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.77 / $194.48 / $311.99
| Professional | | $144.77 | $194.48 | $311.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.90 / $4,287.00 / $9,401.00
| Facility | | $389.90 | $4,287.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.95 / $381.66 / $1,703.33
| Professional | | $183.95 | $381.66 | $1,703.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.67 / $259.14 / $462.63
| Facility | | $201.67 | $259.14 | $462.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.74 / $385.47 / $566.98
| Professional | | $282.74 | $385.47 | $566.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.22 / $337.17 / $610.67
| Professional | | $196.22 | $337.17 | $610.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.30 / $367.72 / $6,679.00
| Facility | | $173.30 | $367.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.36 / $330.19 / $455.79
| Professional | | $271.36 | $330.19 | $455.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $460.07 / $669.22
| Professional | | $217.50 | $460.07 | $669.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.18 / $4,983.00 / $26,542.00
| Facility | | $1,167.18 | $4,983.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.20 / $455.00 / $1,703.33
| Professional | | $225.20 | $455.00 | $1,703.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.68 / $346.65 / $699.12
| Professional | | $221.68 | $346.65 | $699.12 |