- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,818.38 / $5,128.61
| Facility | | $389.05 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $812.83
| Professional | | $239.88 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,951.21 / $13,489.63
| Facility | | $588.84 | $2,951.21 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $1,148.15
| Professional | | $281.84 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $691.83
| Facility | | $302.00 | $302.00 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $524.81 / $1,000.00
| Professional | | $302.00 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $512.86 / $954.99
| Professional | | $275.42 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $389.05 / $7,079.46
| Facility | | $177.83 | $389.05 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $741.31
| Professional | | $436.52 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $977.24
| Professional | | $288.40 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,951.21 / $13,489.63
| Facility | | $588.84 | $2,951.21 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $1,148.15
| Professional | | $281.84 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,981.07 / $9,120.11
| Facility | | $1,862.09 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $1,000.00
| Professional | | $288.40 | $501.19 | $1,000.00 |