- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.24 / $2,096.25 / $3,693.00
| Facility | | $807.24 | $2,096.25 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.97 / $127.58 / $448.07
| Professional | | $108.97 | $127.58 | $448.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.39 / $947.00 / $2,733.00
| Facility | | $295.39 | $947.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.79 / $202.27 / $1,634.59
| Professional | | $111.79 | $202.27 | $1,634.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,604.45 / $13,637.55 / $13,637.55
| Facility | | $13,604.45 | $13,637.55 | $13,637.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.21 / $186.16 / $338.43
| Professional | | $119.21 | $186.16 | $338.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.02 / $158.02 / $185.90
| Professional | | $158.02 | $158.02 | $185.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $274.35 / $361.14
| Professional | | $145.00 | $274.35 | $361.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.51 / $3,863.50 / $25,429.46
| Facility | | $1,842.51 | $3,863.50 | $25,429.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.76 / $178.76 / $1,937.15
| Professional | | $178.76 | $178.76 | $1,937.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,818.00 / $3,445.00
| Facility | | $308.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.91 / $202.27 / $1,634.59
| Professional | | $116.91 | $202.27 | $1,634.59 |
- 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
- $117.91 / $186.63 / $399.07
| Professional | | $117.91 | $186.63 | $399.07 |