- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.67 / $2,079.00 / $4,073.17
| Facility | | $188.67 | $2,079.00 | $4,073.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.53 / $207.84 / $541.21
| Professional | | $110.53 | $207.84 | $541.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.34 / $2,411.51 / $10,821.00
| Facility | | $391.34 | $2,411.51 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.07 / $397.36 / $1,562.88
| Professional | | $174.07 | $397.36 | $1,562.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.55 / $238.62 / $421.06
| Facility | | $183.55 | $238.62 | $421.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.00 / $301.00 / $441.67
| Professional | | $301.00 | $301.00 | $441.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.43 / $418.50 / $709.63
| Professional | | $234.43 | $418.50 | $709.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.83 / $334.68 / $6,679.00
| Facility | | $154.83 | $334.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.72 / $320.61 / $573.23
| Professional | | $253.72 | $320.61 | $573.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.35 / $406.55 / $593.80
| Professional | | $189.35 | $406.55 | $593.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $0.85 / $0.85
| Facility | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.92 / $407.92 / $407.92
| Professional | | $407.92 | $407.92 | $407.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.83 / $3,649.00 / $12,000.00
| Facility | | $1,029.83 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.08 / $557.23 / $1,562.88
| Professional | | $250.08 | $557.23 | $1,562.88 |
- 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
- $214.73 / $322.70 / $713.40
| Professional | | $214.73 | $322.70 | $713.40 |