- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.55 / $1,758.00 / $3,398.55
| Facility | | $369.55 | $1,758.00 | $3,398.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.74 / $451.49 / $854.83
| Professional | | $220.74 | $451.49 | $854.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.60 / $2,854.00 / $9,039.00
| Facility | | $411.60 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.83 / $654.55 / $3,336.50
| Professional | | $224.83 | $654.55 | $3,336.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.76 / $260.55 / $465.13
| Facility | | $202.76 | $260.55 | $465.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.27 / $421.16 / $728.86
| Professional | | $284.27 | $421.16 | $728.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.80 / $474.22 / $1,147.33
| Professional | | $249.80 | $474.22 | $1,147.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.99 / $369.70 / $6,679.00
| Facility | | $177.99 | $369.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.67 / $409.04 / $563.16
| Professional | | $337.67 | $409.04 | $563.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.24 / $482.01 / $848.70
| Professional | | $229.24 | $482.01 | $848.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $3,025.53 / $6,134.64
| Facility | | $2,941.55 | $3,025.53 | $6,134.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.47 / $362.22 / $949.49
| Professional | | $135.47 | $362.22 | $949.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.42 / $3,764.00 / $16,394.00
| Facility | | $1,039.42 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.45 / $971.03 / $3,336.50
| Professional | | $506.45 | $971.03 | $3,336.50 |
- 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
- $456.77 / $752.74 / $1,566.06
| Professional | | $456.77 | $752.74 | $1,566.06 |