- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.01 / $2,083.00 / $3,685.00
| Facility | | $253.01 | $2,083.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.51 / $251.32 / $445.89
| Professional | | $147.51 | $251.32 | $445.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.89 / $2,329.00 / $4,689.00
| Facility | | $259.89 | $2,329.00 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.52 / $416.52 / $1,903.04
| Professional | | $181.52 | $416.52 | $1,903.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.20 / $237.98 / $424.85
| Facility | | $185.20 | $237.98 | $424.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.57 / $360.92 / $682.05
| Professional | | $196.57 | $360.92 | $682.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.19 / $337.70 / $6,679.00
| Facility | | $159.19 | $337.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.29 / $373.69 / $517.28
| Professional | | $306.29 | $373.69 | $517.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.57 / $427.32 / $767.56
| Professional | | $202.57 | $427.32 | $767.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.41 / $3,072.75 / $3,341.25
| Facility | | $2,104.41 | $3,072.75 | $3,341.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.71 / $325.05 / $326.97
| Professional | | $203.71 | $325.05 | $326.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.06 / $572.54 / $1,903.04
| Professional | | $267.06 | $572.54 | $1,903.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.58 / $411.47 / $898.56
| Professional | | $256.58 | $411.47 | $898.56 |