- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.32 / $3,107.00 / $5,851.00
| Facility | | $209.32 | $3,107.00 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.87 / $289.87 / $473.93
| Professional | | $198.87 | $289.87 | $473.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.19 / $2,410.09 / $26,542.00
| Facility | | $550.19 | $2,410.09 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.83 / $599.86 / $2,681.20
| Professional | | $282.83 | $599.86 | $2,681.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.19 / $339.48 / $605.52
| Facility | | $264.19 | $339.48 | $605.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.68 / $1,620.25 / $1,620.25
| Professional | | $1,351.68 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.00 / $1,457.50 / $3,103.98
| Facility | | $1,325.00 | $1,457.50 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.48 / $471.57 / $968.61
| Professional | | $252.48 | $471.57 | $968.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.91 / $1,129.00 / $7,315.92
| Facility | | $225.91 | $1,129.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.94 / $562.46 / $803.63
| Professional | | $432.94 | $562.46 | $803.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.89 / $604.23 / $1,016.13
| Professional | | $321.89 | $604.23 | $1,016.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $26,542.00
| Facility | | $1,061.00 | $2,854.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.38 / $889.30 / $2,681.20
| Professional | | $353.38 | $889.30 | $2,681.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.81 / $532.95 / $1,312.82
| Professional | | $330.81 | $532.95 | $1,312.82 |