- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.58 / $2,581.76 / $3,625.00
| Facility | | $228.58 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.62 / $228.58 / $440.73
| Professional | | $145.62 | $228.58 | $440.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.08 / $3,764.00 / $12,379.00
| Facility | | $350.08 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.11 / $392.79 / $1,728.01
| Professional | | $161.11 | $392.79 | $1,728.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.56 / $219.13 / $386.68
| Facility | | $168.56 | $219.13 | $386.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.75 / $337.02 / $549.37
| Professional | | $200.75 | $337.02 | $549.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.32 / $395.44 / $748.56
| Professional | | $218.32 | $395.44 | $748.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.77 / $307.33 / $6,679.00
| Facility | | $146.77 | $307.33 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $266.50 / $409.68
| Professional | | $138.38 | $266.50 | $409.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $395.20 / $602.89
| Professional | | $183.48 | $395.20 | $602.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.20 / $2,629.20 / $2,629.20
| Facility | | $2,629.20 | $2,629.20 | $2,629.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.12 / $410.94 / $410.94
| Professional | | $199.12 | $410.94 | $410.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.15 / $4,249.00 / $16,394.00
| Facility | | $720.15 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.11 / $660.35 / $1,728.01
| Professional | | $268.11 | $660.35 | $1,728.01 |
- 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
- $257.22 / $432.31 / $774.88
| Professional | | $257.22 | $432.31 | $774.88 |