- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.64 / $2,663.12 / $4,767.00
| Facility | | $264.64 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.24 / $306.70 / $1,353.00
| Professional | | $202.24 | $306.70 | $1,353.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.22 / $3,764.00 / $12,379.00
| Facility | | $485.22 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.43 / $506.51 / $1,863.68
| Professional | | $214.43 | $506.51 | $1,863.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.80 / $305.24 / $538.63
| Facility | | $234.80 | $305.24 | $538.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.66 / $431.24 / $628.09
| Professional | | $331.66 | $431.24 | $628.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.91 / $497.45 / $981.87
| Professional | | $285.91 | $497.45 | $981.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.82 / $304.56 / $6,679.00
| Facility | | $199.82 | $304.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.71 / $307.57 / $475.06
| Professional | | $159.71 | $307.57 | $475.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.43 / $539.98 / $755.07
| Professional | | $254.43 | $539.98 | $755.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,351.18 / $4,351.18 / $4,351.18
| Facility | | $4,351.18 | $4,351.18 | $4,351.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.50 / $293.50 / $315.45
| Professional | | $293.50 | $293.50 | $315.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.20 / $4,249.00 / $16,394.00
| Facility | | $1,003.20 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.85 / $758.31 / $1,863.68
| Professional | | $297.85 | $758.31 | $1,863.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.31 / $431.73 / $893.20
| Professional | | $296.31 | $431.73 | $893.20 |