- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.35 / $2,663.12 / $4,410.00
| Facility | | $422.35 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.23 / $408.37 / $662.59
| Professional | | $214.23 | $408.37 | $662.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.99 / $2,854.00 / $9,039.00
| Facility | | $324.99 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.54 / $552.60 / $2,701.08
| Professional | | $178.54 | $552.60 | $2,701.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.87 / $206.72 / $376.27
| Facility | | $160.87 | $206.72 | $376.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.61 / $357.37 / $534.77
| Professional | | $209.61 | $357.37 | $534.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.66 / $400.29 / $934.68
| Professional | | $205.66 | $400.29 | $934.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.22 / $300.00 / $6,679.00
| Facility | | $141.22 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.17 / $339.38 / $468.02
| Professional | | $280.17 | $339.38 | $468.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.06 / $380.96 / $702.63
| Professional | | $181.06 | $380.96 | $702.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.94 / $143.94 / $143.94
| Professional | | $143.94 | $143.94 | $143.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.91 / $3,764.00 / $26,542.00
| Facility | | $875.91 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.45 / $803.93 / $2,701.08
| Professional | | $414.45 | $803.93 | $2,701.08 |
- 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
- $383.12 / $621.64 / $1,202.19
| Professional | | $383.12 | $621.64 | $1,202.19 |