- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.52 / $2,747.00 / $5,011.00
| Facility | | $196.52 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.93 / $196.52 / $482.07
| Professional | | $162.93 | $196.52 | $482.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.64 / $2,628.00 / $26,542.00
| Facility | | $504.64 | $2,628.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.77 / $377.71 / $1,461.44
| Professional | | $206.77 | $377.71 | $1,461.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.50 / $855.84 / $1,620.25
| Professional | | $396.50 | $855.84 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $3,103.98
| Facility | | $837.00 | $920.70 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.18 / $356.75 / $628.85
| Professional | | $210.18 | $356.75 | $628.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.67 / $578.00 / $6,679.00
| Facility | | $206.67 | $578.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.51 / $297.58 / $431.58
| Professional | | $232.51 | $297.58 | $431.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.45 / $492.41 / $635.85
| Professional | | $249.45 | $492.41 | $635.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,115.38 / $4,115.38 / $4,115.38
| Facility | | $4,115.38 | $4,115.38 | $4,115.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.29 / $377.71 / $1,461.44
| Professional | | $216.29 | $377.71 | $1,461.44 |
- 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
- $205.77 / $309.64 / $629.22
| Professional | | $205.77 | $309.64 | $629.22 |