- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.86 / $5,116.62 / $18,800.00
| Facility | | $355.86 | $5,116.62 | $18,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.93 / $261.52 / $512.77
| Professional | | $194.93 | $261.52 | $512.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.64 / $18,231.29 / $37,102.31
| Facility | | $253.64 | $18,231.29 | $37,102.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.50 / $456.75 / $1,553.85
| Professional | | $277.50 | $456.75 | $1,553.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.13 / $391.39 / $559.91
| Professional | | $250.13 | $391.39 | $559.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.01 / $466.17 / $6,626.05
| Facility | | $271.01 | $466.17 | $6,626.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.01 / $432.03 / $4,331.04
| Professional | | $271.01 | $432.03 | $4,331.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.16 / $271.92 / $446.56
| Professional | | $43.16 | $271.92 | $446.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.23 / $362.18 / $395.20
| Facility | | $274.23 | $362.18 | $395.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.64 / $253.64 / $260.02
| Facility | | $253.64 | $253.64 | $260.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.58 / $436.45 / $520.20
| Professional | | $281.58 | $436.45 | $520.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,577.42 / $19,384.89 / $37,102.31
| Facility | | $12,577.42 | $19,384.89 | $37,102.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.19 / $369.91 / $496.51
| Professional | | $265.19 | $369.91 | $496.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,297.00 / $12,835.00
| Facility | | $2,155.00 | $3,297.00 | $12,835.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.84 / $392.70 / $557.10
| Professional | | $246.84 | $392.70 | $557.10 |