- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.24 / $2,663.12 / $3,693.00
| Facility | | $214.24 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.04 / $227.34 / $486.00
| Professional | | $190.04 | $227.34 | $486.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.18 / $3,764.00 / $12,379.00
| Facility | | $446.18 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.55 / $437.29 / $2,323.59
| Professional | | $172.55 | $437.29 | $2,323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.79 / $281.39 / $497.32
| Facility | | $216.79 | $281.39 | $497.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.99 / $408.18 / $797.31
| Professional | | $252.99 | $408.18 | $797.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.41 / $395.30 / $6,679.00
| Facility | | $188.41 | $395.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.85 / $244.66 / $394.44
| Professional | | $131.85 | $244.66 | $394.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.79 / $473.53 / $669.47
| Professional | | $229.79 | $473.53 | $669.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.58 / $1,928.58 / $1,928.58
| Facility | | $1,928.58 | $1,928.58 | $1,928.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.20 / $298.20 / $443.63
| Professional | | $298.20 | $298.20 | $443.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.00 / $4,249.00 / $16,394.00
| Facility | | $1,065.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.09 / $523.48 / $2,323.59
| Professional | | $254.09 | $523.48 | $2,323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.02 / $323.39 / $750.85
| Professional | | $237.02 | $323.39 | $750.85 |