- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.75 / $2,747.00 / $5,011.00
| Facility | | $242.75 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.08 / $259.14 / $406.05
| Professional | | $224.08 | $259.14 | $406.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.01 / $2,628.00 / $26,542.00
| Facility | | $611.01 | $2,628.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.95 / $471.23 / $1,806.96
| Professional | | $256.95 | $471.23 | $1,806.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.39 / $855.84 / $1,620.25
| Professional | | $486.39 | $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
- $264.49 / $423.16 / $775.18
| Professional | | $264.49 | $423.16 | $775.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.58 / $714.00 / $6,679.00
| Facility | | $254.58 | $714.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.39 / $365.05 / $539.39
| Professional | | $286.39 | $365.05 | $539.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.43 / $608.84 / $786.19
| Professional | | $308.43 | $608.84 | $786.19 |
- 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
- $274.70 / $471.23 / $1,806.96
| Professional | | $274.70 | $471.23 | $1,806.96 |
- 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
- $262.17 / $390.01 / $807.13
| Professional | | $262.17 | $390.01 | $807.13 |