- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.11 / $2,663.12 / $4,410.00
| Facility | | $192.11 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.45 / $202.54 / $291.62
| Professional | | $173.45 | $202.54 | $291.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.83 / $2,628.00 / $26,542.00
| Facility | | $494.83 | $2,628.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.66 / $370.20 / $1,429.92
| Professional | | $202.66 | $370.20 | $1,429.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $1,620.25 / $1,620.25
| Professional | | $692.82 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,103.98
| Facility | | $680.00 | $748.00 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.16 / $364.29 / $616.44
| Professional | | $207.16 | $364.29 | $616.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.33 / $578.00 / $6,679.00
| Facility | | $202.33 | $578.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.62 / $291.47 / $422.51
| Professional | | $227.62 | $291.47 | $422.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.12 / $481.89 / $622.26
| Professional | | $244.12 | $481.89 | $622.26 |
- 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
- $214.37 / $371.96 / $1,429.92
| Professional | | $214.37 | $371.96 | $1,429.92 |
- 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
- $197.88 / $300.68 / $703.39
| Professional | | $197.88 | $300.68 | $703.39 |